Blackburn, Devon M

Blackburn, Devon M is an individual health care provider with primary practice located at 1800 N Capitol Ave Np E-140, Indianapolis IN 46202-1218. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Gerontology, Physician Assistants & Advanced Practice Nursing Providers / Adult Health. Physician Assistants & Advanced Practice Nursing Providers / Adult Health is her primary health care specialty. Blackburn, Devon M can be contacted via phone (317) 962-2894.

Contact Information

Primary practice address
1800 N Capitol Ave Np E-140 Indianapolis IN 46202-1218
Phone: (317) 962-2894
Fax: (317) 963-5285
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Gerontology 363LG0600X 71005960A Indiana
Physician Assistants & Advanced Practice Nursing Providers / Adult Health 363LA2200X 71005960A Indiana

Profile Details

NPI number 1255706602
LBN Legal business name Blackburn, Devon M
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 10th, 2015
Last updated Jan 28th, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1255706602 NPPES
Indiana MEDICAID 201336430

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