Individual
MRS. BETTIE BLACKMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
11990 JACKSON ST, CLINTON, LA 70722-3210
(225) 683-5292
(225) 683-3411
Mailing address
PO BOX 395, CLINTON, LA 70722-0395
(225) 683-5292
(225) 683-3411
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP03903
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1114367
—
LA
Enumeration date
05/27/2005
Last updated
03/07/2023
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