Individual
KATRINA MARIE BLACKARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
401 SOUTHCREST CIR STE 212, SOUTHAVEN, MS 38671-6721
(662) 349-0488
(662) 349-5974
Mailing address
965 RIDGE LAKE BLVD STE 315, MEMPHIS, TN 38120-9401
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
28617
TN
363LP2300X
Primary Care Nurse Practitioner
Primary
904313
MS
Other
Enumeration date
10/23/2020
Last updated
07/13/2022
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