Provider Demographics
NPI:1467740779
Name:BLACKBURN, KAREN R
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:R
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 1:122 1ST AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-4803
Mailing Address - Country:US
Mailing Address - Phone:907-452-6434
Mailing Address - Fax:907-457-6598
Practice Address - Street 1:909 CUSHMAN ST STE 103
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4668
Practice Address - Country:US
Practice Address - Phone:907-456-4620
Practice Address - Fax:907-457-6598
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-20
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251B00000XAgenciesCase Management
No171M00000XOther Service ProvidersCase Manager/Care Coordinator