Provider Demographics
NPI:1679542575
Name:BLACKWELDER, JAMIE MORGAN (ENP)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:MORGAN
Last Name:BLACKWELDER
Suffix:
Gender:F
Credentials:ENP
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:THOMAS
Other - Last Name:MORGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ENP
Mailing Address - Street 1:1140 JAMIE LN
Mailing Address - Street 2:
Mailing Address - City:GERMANTON
Mailing Address - State:NC
Mailing Address - Zip Code:27019-9157
Mailing Address - Country:US
Mailing Address - Phone:336-994-4005
Mailing Address - Fax:
Practice Address - Street 1:J R JONES MEDICAL CENTER
Practice Address - Street 2:402 WEST KING ST
Practice Address - City:KING
Practice Address - State:NC
Practice Address - Zip Code:27021
Practice Address - Country:US
Practice Address - Phone:336-983-9617
Practice Address - Fax:336-983-9791
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC700003363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP54878Medicare UPIN