# BLACKHAWK MEDICAL, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1710807664
- **Authorized official:** VIRGINIA LEA POWELL A-GPCNP (OWNER, NURSE PRACTITIONER)
- **Authorized official phone:** (601) 624-1082

## Contact information

- **Practice address:** 115 AULENBROCK DR \# 100-B, CANTON, MS 39046-7061
- **Practice address phone:** (601) 624-1082
- **Mailing address:** 115 AULENBROCK DR \# 100-B, CANTON, MS 39046-7061
- **Mailing address phone:** (601) 624-1082

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |
| 363LA2200X | Adult Health Nurse Practitioner | — | NULL | Yes |
| 363LA2200X | Adult Health Nurse Practitioner | — | — | Yes |
| 363LG0600X | Gerontology Nurse Practitioner | — | NULL | — |
| 363LG0600X | Gerontology Nurse Practitioner | — | — | — |
| 363LP2300X | Primary Care Nurse Practitioner | — | NULL | — |
| 363LP2300X | Primary Care Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 07/20/2026
- **Last updated:** 07/20/2026