Provider Demographics
NPI:1700185378
Name:BLACKBURN, JEANNIE ANN (ACNP)
Entity Type:Individual
Prefix:MRS
First Name:JEANNIE
Middle Name:ANN
Last Name:BLACKBURN
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Gender:F
Credentials:ACNP
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Mailing Address - Street 1:4545 POST OAK PLACE DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-3164
Mailing Address - Country:US
Mailing Address - Phone:713-960-8008
Mailing Address - Fax:713-960-0965
Practice Address - Street 1:4545 POST OAK PLACE DR
Practice Address - Street 2:SUITE 130
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-3164
Practice Address - Country:US
Practice Address - Phone:713-960-8008
Practice Address - Fax:713-960-0965
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-22
Last Update Date:2017-03-30
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Provider Licenses
StateLicense IDTaxonomies
TX665439364SA2100X, 364SR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute Care
No364SR0400XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistRehabilitation