Provider Demographics
NPI:1609976786
Name:BLACKWELL, EARNIE M (WHNP, RNC)
Entity Type:Individual
Prefix:MS
First Name:EARNIE
Middle Name:M
Last Name:BLACKWELL
Suffix:
Gender:F
Credentials:WHNP, RNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10818 HILLSDALE LOOP
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-3887
Mailing Address - Country:US
Mailing Address - Phone:210-558-9993
Mailing Address - Fax:
Practice Address - Street 1:104 BABCOCK RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78201-3806
Practice Address - Country:US
Practice Address - Phone:210-736-0011
Practice Address - Fax:210-736-0011
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX245735363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX85N687Medicare UPIN
TXP24216Medicare UPIN