Basic Information
| Provider Information | |||||||||
| NPI: | 1023327814 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BLANEY | ||||||||
| FirstName: | KRISTY | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | RN, APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 PHYSICIANS WAY | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | LEBANON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370908102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6154443307 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 100 PHYSICIANS WAY | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | LEBANON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370908102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6154443307 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2010 | ||||||||
| LastUpdateDate: | 04/29/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 15335 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 163W00000X | 172789 | TN | N | Nursing Service Providers | Registered Nurse |
No ID Information.