Individual provider · NPI-1

Derek Blankenship, PA-C

Physician Assistant · Jackson, TN

NPI number1194106690
StatusActive
Last updated in NPPESOct 5, 2015

Details

NPI
1194106690
Entity type
Individual (NPI-1)
Name
Derek Blankenship
Credential
PA-C
Sex
Male
Sole proprietor
No
Enumeration date
Jun 10, 2015
Last updated
Oct 5, 2015

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
363A00000X Physician Assistant2793TNYes

Practice location

620 Skyline Dr
Jackson, TN 38301-3923

Phone 731-541-6180

Mailing address

620 Skyline Dr
Jackson, TN 38301-3923

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