Provider Demographics
NPI:1023615713
Name:BLANTON, VICKY S (APRN)
Entity type:Individual
Prefix:MRS
First Name:VICKY
Middle Name:S
Last Name:BLANTON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 RICHMOND RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1599
Mailing Address - Country:US
Mailing Address - Phone:859-623-5155
Mailing Address - Fax:
Practice Address - Street 1:3101 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1599
Practice Address - Country:US
Practice Address - Phone:859-623-5155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-06
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3015274363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily