MEDICARE: MRS. JAMIE MORGAN BLACKWELDER ENP

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	363L00000X	Nurse Practitioner	700003	NC

General Provider Information

NPI Number	:	1679542575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JAMIE MORGAN BLACKWELDER ENP

Provider Business Mailing Address
First Line	:	1140 JAMIE LN
Second Line	:
City	:	GERMANTON
State	:	NC
Zip	:	27019-9157
Country	:	US
Telephone Number	:	336-994-4005
Fax Number	:

Provider Business Practice Location Address
First Line	:	J R JONES MEDICAL CENTER
Second Line	:	402 WEST KING ST
City	:	KING
State	:	NC
Zip	:	27021
Country	:	US
Telephone Number	:	336-983-9617
Fax Number	:	336-983-9791

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

Provider Enumeration Date	:	03/15/2006
Last Update Date	:	07/08/2007

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