Individual
MS. TRACELYNN JENNINGS BLACKWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
3000 NEW BERN AVE, RALEIGH, NC 27610-1231
(919) 350-8000
Mailing address
2920 HIGHWOODS BLVD, RALEIGH, NC 27604-0010
(877) 498-4490
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA-2008-0010
NM
363AS0400X
Surgical Physician Assistant
Primary
0010-03005
NC
Other
Enumeration date
07/07/2008
Last updated
02/16/2021
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