Individual
BRENT BLACKBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3417 U OF A WAY, TEXARKANA, AR 71854-1419
(870) 779-6000
Mailing address
3417 U OF A WAY, TEXARKANA, AR 71854-1419
(870) 779-6000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
E19988
AR
363LA2100X
Acute Care Nurse Practitioner
A004186
AR
Other
Enumeration date
08/22/2014
Last updated
10/28/2025
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