Individual
MS. MADELINE WOOTEN BLACKWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2601 KENTUCKY AVE STE 201, PADUCAH, KY 42003-3825
(270) 538-9555
(270) 538-9554
Mailing address
345 ODESSA WAY, PADUCAH, KY 42001-8305
(270) 816-4062
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100933030
—
KY
Enumeration date
07/23/2022
Last updated
01/12/2026
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