Provider Demographics
NPI:1568530590
Name:BLACKWOOD, KARLA R (APRN)
Entity Type:Individual
Prefix:MS
First Name:KARLA
Middle Name:R
Last Name:BLACKWOOD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KARLA
Other - Middle Name:R
Other - Last Name:MELVILLE-BLACKWOOD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN
Mailing Address - Street 1:535 FORTUNE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-3429
Mailing Address - Country:US
Mailing Address - Phone:402-933-2222
Mailing Address - Fax:402-505-3886
Practice Address - Street 1:535 FORTUNE DR STE 100
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-3429
Practice Address - Country:US
Practice Address - Phone:402-933-2222
Practice Address - Fax:402-505-3886
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110102363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
35834OtherBCBS
35834OtherBCBS