Individual
JO BLASENGAME
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AGACNP-BC
Contact information
Practice address
1609 W 40TH AVE STE 205, PINE BLUFF, AR 71603-6367
(870) 541-7211
Mailing address
PO BOX 2650, PINE BLUFF, AR 71613-2650
(870) 541-7211
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
217776
AR
363LA2100X
Acute Care Nurse Practitioner
217776
AR
Other
Enumeration date
10/26/2021
Last updated
01/27/2023
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