Healthcare Provider Details

I. General information

NPI: 1417632829
Provider Name (Legal Business Name): KAYLA CHRISTINE BLACKMON MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2023
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8081 TOWNSHIP LINE RD STE 203
INDIANAPOLIS IN
46260-2189
US

IV. Provider business mailing address

8081 TOWNSHIP LINE RD STE 203
INDIANAPOLIS IN
46260-2189
US

V. Phone/Fax

Practice location:
  • Phone: 317-415-7741
  • Fax:
Mailing address:
  • Phone: 734-330-9969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number99119066A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: