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Organization
PRAIRIE FOOT & ANKLE PC
Active
Organization
PRAIRIE FOOT & ANKLE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
COREY S. BLACKBURN (PRESIDENT)
(308) 646-0077
Entity
Organization
Contact information
Practice address
1832 ASPEN LN STE A, GRAND ISLAND, NE 68803-2487
(308) 646-0077
(308) 646-0317
Mailing address
PO BOX 5823, GRAND ISLAND, NE 68802-5823
(308) 646-0077
(308) 646-0317
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
47062497913
—
NE
Enumeration date
09/18/2017
Last updated
07/23/2026
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