Blen D Blackwell, PA-C Valid NPI

Individual provider · Physician Assistant · Hattiesburg, MS

NPI

1811217409

Type

Individual (Type 1)

Primary specialty

Physician Assistant

Specialty group

Physician Assistants & Advanced Practice Nursing Providers

Taxonomy code

363A00000X

License number

PA00132 (MS)

Sex

Male

Sole proprietor

No

Enumerated

2010-06-04

Last updated

2013-08-20