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BRENT BLACKBURN AG-ACNP

Acute Care >> Nurse Practitioner >> Physician Assistants & Advanced Practice Nursing Providers

Registrant NPI Number: 1548669823

Individual Registrant:
 BRENT  BLACKBURN AG-ACNP
Gender: M
Not Sole Proprietor

Location and contact information for practice:
113 WEST RUBY STREET  STEPHENS, AR 71764 US
Tel: 870-786-9114  Fax: --

Contact information for business:
PO BOX 797  CAMDEN, AR 71711-0797 US
Tel: 870-836-1200  Fax: --

Registration Information:
NPI: 1548669823
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y363LA2100XPhysician Assistants & Advanced Practice Nursing Providers
Nurse Practitioner
Acute Care
ARA004186

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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