Organization
TABULA RASA, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN BLANKENSHIP M.D. (DIRECTOR)
(681) 238-5957
Entity
Organization
Contact information
Practice address
1296 ROBERT C. BYRD DR, CRAB ORCHARD, WV 25827
(681) 238-5957
(681) 238-5958
Mailing address
PO BOX 415, CRAB ORCHARD, WV 25827-0415
(681) 238-5957
(681) 238-5958
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
AP00943133
WV
Other
Enumeration date
02/20/2017
Last updated
02/20/2017
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