Provider Demographics
NPI:1447393889
Name:BLACKERBY, WILLIAM F (PHD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:F
Last Name:BLACKERBY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 MEDICAL GROUP
Mailing Address - Street 2:527 GOTT ROAD VANCE AFB
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73705-5105
Mailing Address - Country:US
Mailing Address - Phone:580-213-7419
Mailing Address - Fax:
Practice Address - Street 1:816 E OLDHAM AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917-5567
Practice Address - Country:US
Practice Address - Phone:865-523-9163
Practice Address - Fax:865-525-2958
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000001231103T00000X
TN1231103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN12163042OtherCAQH PIN
TN1519219Medicaid
TN103I689257Medicare PIN