Individual
MRS. SAMANTHA D'ANN BLACKBURN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PMHNP-BC; FNP-C
Contact information
Practice address
3709 N LOCUST GROVE RD STE 150, MERIDIAN, ID 83646-5924
(208) 208-5430
(208) 208-5431
Mailing address
3709 N LOCUST GROVE RD STE 150, MERIDIAN, ID 83646-5924
(208) 208-5430
(208) 208-5431
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
47259
ID
363LA2100X
Acute Care Nurse Practitioner
65041
ID
363LF0000X
Family Nurse Practitioner
65041
ID
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
65041
ID
Other
Enumeration date
11/29/2019
Last updated
05/07/2026
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