Blackburn, Sally
Blackburn, Sally is an individual health care provider with primary practice located at 2195 Euclid Ave Suite 6, Bristol VA 24201-3655. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Blackburn, Sally can be contacted via phone (276) 669-5179.Contact Information
Primary practice address
2195 Euclid Ave Suite 6
Bristol VA 24201-3655
Phone: (276) 669-5179
Fax: (276) 466-8870
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Family | 363LF0000X | 0024164957 | Virginia |
Profile Details
| NPI number | 1700857216 |
|---|---|
| LBN Legal business name | Blackburn, Sally |
| Credentials | Nurse Practitioner (NP) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Feb 1st, 2006 |
| Last updated | Oct 5th, 2016 - about 8 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1700857216 | NPPES |
| Tennessee | MEDICAID | Q006676 |
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