Provider Demographics
NPI:1700771623
Name:BLANKENSHIP, KANDACE
Entity type:Individual
Prefix:
First Name:KANDACE
Middle Name:
Last Name:BLANKENSHIP
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 321
Mailing Address - Street 2:
Mailing Address - City:NORTH MATEWAN
Mailing Address - State:WV
Mailing Address - Zip Code:25688-0321
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:705 RUTHERFORD BRANCH ROAD
Practice Address - Street 2:
Practice Address - City:NORTH MATEWAN
Practice Address - State:WV
Practice Address - Zip Code:25688
Practice Address - Country:US
Practice Address - Phone:681-308-6082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-11
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide