Individual provider Active NPI

Kenneth Roland Blanton, PA

  • Physician Assistant
  • Wilmington, NC
National Provider Identifier
1639194715
Registry record updated Jun 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
100409 Issued in NC
Practice address
2131 S 17TH St
Wilmington, NC 28401-7407
Phone
(910) 667-2606
Fax
(910) 815-5698
NPI assigned
Jul 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Physician Assistant 363A00000X 100409 NC Primary

Addresses

Primary practice location

2131 S 17TH St
Wilmington, NC 28401-7407

Mailing address

PO Box 936857
Atlanta, GA 31193-6857

Other practice location 1

1912 Tradd Ct
Wilmington, NC 28401-6637
Phone (910) 251-3766

Other practice location 2

2153 Valleygate Dr Ste 101
Fayetteville, NC 28304-3667
Phone (910) 672-0350

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kblanton8535@direct.nhrmc.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070712000537 NC Practitioner - Physician Assistant 9133229693 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2131 S 17TH St
Wilmington, NC 28401-7407
Phone (910) 667-5105

231 S 17TH St
Wilmington, NE 28401-7407
Phone (910) 667-5105

800 Jefferson St
Suite 112
Whiteville, NC 28472-3702
Phone (910) 662-9500

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
NMG Health Services LLC CurrentSince May 1, 2021 Accepting new patients
Novant Health New Hanover Regional Medical Center LLC CurrentSince Feb 1, 2021 Accepting new patients
Novant Health New Hanover Regional Medical Center LLC CurrentSince Feb 1, 2021 Accepting new patients
Cumberland County Hospital System Inc CurrentSince Apr 25, 2024 Accepting new patients
New Hanover Medical Group PA Past Accepting new patients

Locations

800 Jefferson St
Ste 112
Whiteville, NC 28472
Phone (910) 642-8164

2131 S 17th St
Wilmington, NC 28401
Phone (910) 342-3000

1912 Tradd Ct
Wilmington, NC 28401
Phone (910) 251-3766

1415 Physicians Dr
Wilmington, NC 28401
Phone (910) 251-3766

109 Scotts Hill Medical Dr
#1
Wilmington, NC 28411

Interoperability endpoints

  • Direct secure messaging: kblanton1004734@direct.novanthealth.org

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750204800000",
    "number": "1639194715",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 936857",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "311936857"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2131 S 17TH ST",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284017407",
            "telephone_number": "910-667-2606",
            "fax_number": "910-815-5698"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1912 Tradd Ct",
            "address_purpose": "LOCATION",
            "city": "Wilmington",
            "state": "NC",
            "postal_code": "284016637",
            "country_code": "US",
            "telephone_number": "910-251-3766",
            "fax_number": "910-251-3760",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2153 Valleygate Dr Ste 101",
            "address_purpose": "LOCATION",
            "city": "Fayetteville",
            "state": "NC",
            "postal_code": "283043667",
            "country_code": "US",
            "telephone_number": "910-672-0350",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLANTON",
        "first_name": "KENNETH",
        "middle_name": "ROLAND",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-12",
        "last_updated": "2025-06-18",
        "certification_date": "2025-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "100409",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kblanton8535@direct.nhrmc.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/PDF/TXT",
            "address_1": "1912 Tradd Ct",
            "city": "Wilmington",
            "state": "NC",
            "country_code": "US",
            "postal_code": "284016637",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Wilmington, NC

Sources for this page

Verify at the official NPI Registry.