MEDICARE: DR. WILLIAM F. BLACKERBY PH.D.

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	103T00000X	Psychologist	0000001231	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	12163042	OTHER	TN	CAQH PIN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447393889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM F. BLACKERBY PH.D.

Provider Business Mailing Address
First Line	:	3393 LAKE BROOK BLVD
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37909-3708
Country	:	US
Telephone Number	:	615-445-9088
Fax Number	:

Provider Business Practice Location Address
First Line	:	141 CHESAPEAKE LN
Second Line	:
City	:	CLARKSVILLE
State	:	TN
Zip	:	37040-5241
Country	:	US
Telephone Number	:	615-445-9088
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	10/23/2025

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