Katelyn Michelle Blanchard, DDS, MSD

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

37083 Issued in TX

Practice address

3824 Southpark Dr
Tyler, TX 75703-1713

Phone

(903) 707-6275

NPI assigned

Jul 7, 2017

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Katelyn Michelle Kennedy Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1499385600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737417600000",
    "number": "1316469653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 691",
            "city": "WHITEHOUSE",
            "state": "TX",
            "postal_code": "757910691",
            "telephone_number": "903-241-5136"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3824 SOUTHPARK DR",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757031713",
            "telephone_number": "903-707-6275"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1501 E Rusk St",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "TX",
            "postal_code": "757665505",
            "country_code": "US",
            "telephone_number": "903-707-6275",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLANCHARD",
        "first_name": "KATELYN",
        "middle_name": "MICHELLE",
        "name_prefix": "Dr.",
        "credential": "DDS, MSD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-07-07",
        "last_updated": "2025-01-21",
        "certification_date": "2025-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "TX",
            "license": "37083",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATELYN",
            "last_name": "KENNEDY",
            "middle_name": "MICHELLE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Bridgett Blackshire
• Genevieve J.T. Blackwelder, M.D.
• Georgia Leigh Blair, MD
• Jennifer Lynn Blakeney, M.S.
• Amanda R Blalock, NP
• Martin R Blanchard Jr., DC
• Holly Akin Blanco, M.D.
• Virginia Blankinship, FNP-C
• Branden Blanton, AGNP
• Kenneth Blanton

• Orthodontics and Dentofacial Orthopedics Dentistry in Tyler, TX
• Providers in Tyler, TX by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.