Organization
HOLISTIC, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SHAWN ROBERT BLANKENSHIP NURSE PRACTITIONER (OWNER)
(304) 553-1576
Entity
Organization
Contact information
Practice address
4815 MACCORKLE AVE SE, CHARLESTON, WV 25304-1948
(681) 265-1693
(681) 265-0990
Mailing address
7 ANCHORS WAY, WINFIELD, WV 25213-9786
(304) 553-1576
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
WV
261QM2500X
Medical Specialty Clinic/Center
—
WV
Other
Enumeration date
01/15/2018
Last updated
08/22/2023
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