Individual
CHRISTOPHER BLACKWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CNP
Contact information
Practice address
107 BALL AVE, TYLERTOWN, MS 39667-2101
(601) 377-1975
(601) 377-1976
Mailing address
107 BALL AVE, TYLERTOWN, MS 39667-2101
(601) 377-1975
(601) 377-1976
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R871872
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01538051
—
MS
01
—
103I507204
MEDICARE PTAN
MS
01
—
9365915
AETNA
MS
01
—
937501
WINDSOR
MS
01
—
P01087211
RAILROAD MEDICARE
MS
Enumeration date
05/17/2012
Last updated
03/15/2021
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