Individual
CAROLYN ANN BLACKBURN
Active
Individual
CAROLYN ANN BLACKBURN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP-C
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
2008017992
MO
363LF0000X
Family Nurse Practitioner
Primary
2017032960
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
420047801
—
MO
Enumeration date
06/18/2017
Last updated
02/11/2025
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