Provider Demographics
NPI:1033702790
Name:BLACKMON, SHERRICA
Entity Type:Individual
Prefix:
First Name:SHERRICA
Middle Name:
Last Name:BLACKMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 GLACIER DR APT 1
Mailing Address - Street 2:
Mailing Address - City:MINOT AFB
Mailing Address - State:ND
Mailing Address - Zip Code:58704-2281
Mailing Address - Country:US
Mailing Address - Phone:727-460-3444
Mailing Address - Fax:
Practice Address - Street 1:144 GLACIER DR APT 1
Practice Address - Street 2:
Practice Address - City:MINOT AFB
Practice Address - State:ND
Practice Address - Zip Code:58704-2281
Practice Address - Country:US
Practice Address - Phone:727-460-3444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-14
Last Update Date:2021-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula