Individual
CAROL D BLACKSHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN BC
Contact information
Practice address
3535 S JEFFERSON AVE, SUITE 118, SAINT LOUIS, MO 63118-3930
(314) 776-7999
(314) 772-2257
Mailing address
713 THE HAMPTONS LANE, CHESTERFIELD, MO 63017-5901
(314) 268-6195
(314) 645-6478
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
099601
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
427252515
—
MO
Enumeration date
08/07/2006
Last updated
12/18/2012
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