Blackwell, Christopher

Blackwell, Christopher is an individual health care provider with primary practice located at 107 Ball Ave , Tylertown MS 39667-2101. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as his primary health care specialty. Blackwell, Christopher can be contacted via phone (601) 377-1975.

Contact Information

Primary practice address
107 Ball Ave Tylertown MS 39667-2101
Phone: (601) 377-1975
Fax: (601) 377-1976
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X R871872 Mississippi

Profile Details

NPI number 1982964565
LBN Legal business name Blackwell, Christopher
Credentials Certified Nurse Practitioner (CNP)
Entity Individual
Sole proprietor 1 No
Enumeration date May 17th, 2012
Last updated Mar 15th, 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 1982964565 NPPES
Mississippi Other 103I507204 MEDICARE PTAN
Mississippi MEDICAID 01538051 MEDICARE PTAN
Mississippi Other 9365915 MEDICARE PTAN
Mississippi Other 937501 MEDICARE PTAN
Mississippi Other P01087211 MEDICARE PTAN

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