# BRENT BLACKBURN

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1548669823
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | E19988 | AR | Yes |
| 363LA2100X | Acute Care Nurse Practitioner | A004186 | AR | — |

## Other

- **Enumeration date:** 08/22/2014
- **Last updated:** 10/28/2025