Individual
RICKEY ALLEN BLACKBURN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNP
Contact information
Practice address
102 EDWINA ST, EVERGREEN, AL 36401-3319
(251) 578-0220
(251) 578-0223
Mailing address
102 EDWINA ST, EVERGREEN, AL 36401-3319
(251) 578-0220
(251) 578-0223
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
1-131157
AL
Other
Enumeration date
08/04/2017
Last updated
07/25/2024
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