Individual
PATRICIA LOUISE BLACKLEDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP MS
Contact information
Practice address
1015 N 18TH ST, CENTERVILLE, IA 52544-1170
(641) 684-6896
(641) 226-5759
Mailing address
PO BOX 458, OTTUMWA, IA 52501-0458
(641) 684-6896
(641) 226-5759
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
097156
IA
363L00000X
Nurse Practitioner
Primary
A097156
IA
363LF0000X
Family Nurse Practitioner
A097156
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3254342
—
IA
01
—
36504
WELLMARK BCBS OF IA
IA
01
—
420681060C4
JOHN DEERE HEALTH
IA
Enumeration date
08/31/2005
Last updated
12/29/2023
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