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JO BLASENGAME AGACNP-BC
Acute Care >> Nurse Practitioner >> Physician Assistants & Advanced Practice Nursing ProvidersRegistrant NPI Number: 1356005250
Individual Registrant: JO BLASENGAME AGACNP-BC
Gender: F
Sole Proprietor
Gender: F
Sole Proprietor
Location and contact information for practice:
2894 AUTUMN HILLS RD STAR CITY, AR 71667-9554 US
Tel: 870-628-3842 Fax: --
Tel: 870-628-3842 Fax: --
Contact information for business:
2894 AUTUMN HILLS RD STAR CITY, AR 71667-9554 US
Tel: 870-628-3842 Fax: --
Tel: 870-628-3842 Fax: --
Registration Information:
NPI: 1356005250
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 363LA2100X | Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner Acute Care | AR | 217776 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
