Basic Information
Provider Information | |||||||||
NPI: | 1598410888 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BLANKENSHIP | ||||||||
FirstName: | MELODY | ||||||||
MiddleName: | SUE | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | RRT | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | BLANKENSHIP | ||||||||
OtherFirstName: | MELODY | ||||||||
OtherMiddleName: | SUE | ||||||||
OtherNamePrefix: | MRS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | RRT | ||||||||
OtherLastNameType: | 2 | ||||||||
Mailing Information | |||||||||
Address1: | 619 S MARION AVE # 111-A | ||||||||
Address2: |   | ||||||||
City: | LAKE CITY | ||||||||
State: | FL | ||||||||
PostalCode: | 320255808 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3867553016 | ||||||||
FaxNumber: | 3523848130 | ||||||||
Practice Location | |||||||||
Address1: | 619 S MARION AVE | ||||||||
Address2: |   | ||||||||
City: | LAKE CITY | ||||||||
State: | FL | ||||||||
PostalCode: | 320255808 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3867553016 | ||||||||
FaxNumber: | 3523848130 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/16/2022 | ||||||||
LastUpdateDate: | 02/16/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 02/16/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2279C0205X | RT7783 | FL | Y |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Registered | Critical Care |
No ID Information.