Provider Demographics
NPI:1366030090
Name:BLACKBURN, ASHLEY NICOLE
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:NICOLE
Last Name:BLACKBURN
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 1:2981 EMORYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ELK GARDEN
Mailing Address - State:WV
Mailing Address - Zip Code:26717
Mailing Address - Country:US
Mailing Address - Phone:304-813-0717
Mailing Address - Fax:304-788-6363
Practice Address - Street 1:2981 EMORYVILLE RD
Practice Address - Street 2:
Practice Address - City:ELK GARDEN
Practice Address - State:WV
Practice Address - Zip Code:26717-2671
Practice Address - Country:US
Practice Address - Phone:304-813-0717
Practice Address - Fax:304-788-6363
Is Sole Proprietor?:No
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant