Individual
AMBER R. BLACKLEDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4 NORTHRIDGE DR, BUCKHANNON, WV 26201-8482
(304) 473-1440
Mailing address
PO BOX 479, KOPPEL, PA 16136-0479
(724) 312-0429
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
MA060316
PA
363AM0700X
Medical Physician Assistant
Primary
MA060316
PA
Other
Enumeration date
01/09/2019
Last updated
01/09/2019
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