Provider Demographics
NPI:1497001721
Name:BLACKBURN, BILLIE CAROL (FNP-BC)
Entity Type:Individual
Prefix:
First Name:BILLIE
Middle Name:CAROL
Last Name:BLACKBURN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:BILLIE
Other - Middle Name:CAROL
Other - Last Name:BLACKBURN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1321A INTERSTATE PKWY
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-5626
Mailing Address - Country:US
Mailing Address - Phone:706-922-9311
Mailing Address - Fax:706-922-9267
Practice Address - Street 1:1321A INTERSTATE PKWY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-5626
Practice Address - Country:US
Practice Address - Phone:706-922-9311
Practice Address - Fax:706-922-9267
Is Sole Proprietor?:No
Enumeration Date:2012-07-24
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN 173529363LF0000X
SC18651363LF0000X
GA173529363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily