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NPI Code Detail

MEDICARE: KATRENA BLACKWELL MSN, PMHCNS, ARNP-BC

MEDICARE: KATRENA BLACKWELL MSN, PMHCNS, ARNP-BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1364SP0809XAdult Psychiatric/Mental Health Clinical Nurse Specialist1724SKY

General Provider Information

NPI Number : 1205918224
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATRENA BLACKWELL MSN, PMHCNS, ARNP-BC
Provider Business Mailing Address
First Line : 11705 PILOT ROCK RD
Second Line :
City : HOPKINSVILLE
State : KY
Zip : 42240-8921
Country : US
Telephone Number : 270-886-2507
Fax Number :
Provider Business Practice Location Address
First Line : 739 NORTH DR
Second Line :
City : HOPKINSVILLE
State : KY
Zip : 42240-2620
Country : US
Telephone Number : 270-886-5163
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/19/2006
Last Update Date : 01/11/2019

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