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
1	364SP0809X	Adult Psychiatric/Mental Health Clinical Nurse Specialist	1724S	KY

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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