Provider Demographics
NPI:1114528494
Name:BLACKMON, KARI NICOLE
Entity Type:Individual
Prefix:MISS
First Name:KARI
Middle Name:NICOLE
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 1:4 A ST SW
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36265-2402
Mailing Address - Country:US
Mailing Address - Phone:256-454-7501
Mailing Address - Fax:
Practice Address - Street 1:200 VESTAVIA PKWY STE 2400
Practice Address - Street 2:
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35216-3797
Practice Address - Country:US
Practice Address - Phone:205-490-3931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-04
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician