Healthcare Provider Details

I. General information

NPI: 1558733493
Provider Name (Legal Business Name): JENNIFER BLACKWELL MPAS, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2015
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 N ST STE 102
ANCHORAGE AK
99501-3285
US

IV. Provider business mailing address

1221 HUFFMAN PARK DR UNIT 111074
ANCHORAGE AK
99511-0559
US

V. Phone/Fax

Practice location:
  • Phone: 907-891-8327
  • Fax: 907-931-6167
Mailing address:
  • Phone: 907-891-8327
  • Fax: 907-931-6167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0006063
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA8212
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number239153
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: