Provider Demographics
NPI:1902042807
Name:BLACKMON, USHIKIA SHARI (CNA)
Entity Type:Individual
Prefix:
First Name:USHIKIA
Middle Name:SHARI
Last Name:BLACKMON
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 345
Mailing Address - Street 2:
Mailing Address - City:SIMONTON
Mailing Address - State:TX
Mailing Address - Zip Code:77476
Mailing Address - Country:US
Mailing Address - Phone:281-610-8058
Mailing Address - Fax:281-346-0979
Practice Address - Street 1:8735 POOL HILL RD.
Practice Address - Street 2:
Practice Address - City:SIMONTON
Practice Address - State:TX
Practice Address - Zip Code:77476
Practice Address - Country:US
Practice Address - Phone:281-610-8058
Practice Address - Fax:281-346-0979
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-23
Last Update Date:2008-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXNA00698086376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide