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Individual
KELLY ANN BLACKMON
Active
Individual
KELLY ANN BLACKMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
305220
NY
363LA2200X
Adult Health Nurse Practitioner
Primary
F305220-01
NY
Other
Enumeration date
07/31/2009
Last updated
02/16/2026
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