Healthcare Provider Details

I. General information

NPI: 1013870989
Provider Name (Legal Business Name): CASSIDY BLACKWIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2025
Last Update Date: 12/13/2025
Certification Date: 12/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 DICKSON AVE KELOWNA B.C.
KELOWNA BRITISH COLUMBIA
V1Y 9Y8
CA

IV. Provider business mailing address

1550 DICKSON AVE KELOWNA B.C. 204
KELOWNA BRITISH COLUMBIA
V1Y 9Y8
CA

V. Phone/Fax

Practice location:
  • Phone:
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: