Individual
MRS. VICKIE MARIE BLACKBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1721 EBENEZER RD STE 175, ROCK HILL, SC 29732-1188
(803) 324-5256
(803) 328-0440
Mailing address
PO BOX 604350, CHARLOTTE, NC 28260-4350
(704) 364-8100
(704) 365-2073
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
2650
SC
363L00000X
Nurse Practitioner
5014444
NC
363LA2100X
Acute Care Nurse Practitioner
2650
SC
Other
Enumeration date
06/01/2005
Last updated
03/26/2025
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