Individual
DR. KENDALL LEON BLACKWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
1704 GLENDALE DR SW, SUITE A, WILSON, NC 27893-4678
(252) 237-0138
(252) 237-7903
Mailing address
1704 GLENDALE DR SW, WILSON, NC 27893-4678
(252) 237-0138
Taxonomy
Speciality
Code
Description
License number
State
213EP1101X
Primary Podiatric Medicine Podiatrist
Primary
238
NC
213ES0103X
Foot & Ankle Surgery Podiatrist
238
NC
213ES0131X
Foot Surgery Podiatrist
238
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
79-0804G
—
NC
Enumeration date
06/09/2006
Last updated
08/09/2022
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