Individual
DEREK BLANKENSHIP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
620 SKYLINE DR, JACKSON, TN 38301-3923
(731) 541-6180
Mailing address
620 SKYLINE DR, JACKSON, TN 38301-3923
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2793
TN
Other
Enumeration date
06/10/2015
Last updated
10/05/2015
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