Provider Demographics
NPI:1417054875
Name:BLACKWELL, TERRY DEAN (PA-C)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:DEAN
Last Name:BLACKWELL
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:905 WATTLE BIRD DRIVE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28312
Mailing Address - Country:US
Mailing Address - Phone:910-644-4283
Mailing Address - Fax:
Practice Address - Street 1:BLDG 5-4257
Practice Address - Street 2:BASTOGNE STREET EXTENSION
Practice Address - City:FT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310
Practice Address - Country:US
Practice Address - Phone:910-907-9723
Practice Address - Fax:910-907-8011
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2010-11-18
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant