Individual
KELECHI BLANTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
601 S CLAY ST STE 105, ENNIS, TX 75119-5771
(972) 875-6600
Mailing address
PO BOX 542922, GRAND PRAIRIE, TX 75054-2922
(612) 235-9988
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
AP141146
TX
363LG0600X
Gerontology Nurse Practitioner
AP141146
TX
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
AP141146
TX
Other
Enumeration date
06/17/2019
Last updated
11/04/2025
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