Individual
MS. VICKI M BLACKWELL
Active
Individual
MS. VICKI M BLACKWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA9120078
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
051553463
—
AL
01
—
51514981BUR
BLUE CROSS OF ALABAMA
AL
01
—
P00010094
RR MEDICARE
AL
Enumeration date
07/12/2006
Last updated
05/01/2025
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