Basic Information
| Provider Information | |||||||||
| NPI: | 1851993414 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BLANKENSHIP | ||||||||
| FirstName: | JESSICA | ||||||||
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| Credential: | RDMS, RVT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6505 NW 134TH ST | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731425906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4055355402 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5501 N PORTLAND AVE | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731122074 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056046000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2020 | ||||||||
| LastUpdateDate: | 11/09/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246XS1301X | 212875 | OK | Y | Technologists, Technicians & Other Technical Service Providers | Spec/Tech, Cardiovascular | Sonography |
No ID Information.