MEDICARE: HALYN BLACKBURN FNP-C

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	363LF0000X	Family Nurse Practitioner	F02260495	NC

General Provider Information

NPI Number	:	1538014311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HALYN BLACKBURN FNP-C

Provider Business Mailing Address
First Line	:	128 LIGHTHOUSE DR
Second Line	:
City	:	CAROLINA BEACH
State	:	NC
Zip	:	28428-4725
Country	:	US
Telephone Number	:	910-877-8559
Fax Number	:

Provider Business Practice Location Address
First Line	:	703 SAINT JOSEPH ST UNIT 101
Second Line	:
City	:	CAROLINA BEACH
State	:	NC
Zip	:	28428-3857
Country	:	US
Telephone Number	:	910-877-8559
Fax Number	:

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

Provider Enumeration Date	:	02/26/2026
Last Update Date	:	02/26/2026

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