Individual
MRS. AMANDA J. BLACKBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1484 LAKESIDE DR, JACKSON, KY 41339-6555
(606) 666-9950
(606) 666-9136
Mailing address
PO BOX 690, BEATTYVILLE, KY 41311-0690
(606) 464-0151
(606) 464-0152
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA804
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
950041230
—
KY
Enumeration date
10/03/2005
Last updated
05/19/2022
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