Healthcare Provider Details

I. General information

NPI: 1376961425
Provider Name (Legal Business Name): KARI JUNE BLACKBURN DNP, CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2014
Last Update Date: 09/25/2020
Certification Date: 09/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 GREATSTONE PT
LEXINGTON KY
40504-3274
US

IV. Provider business mailing address

4701 SPRING CREEK DR
LEXINGTON KY
40515-1523
US

V. Phone/Fax

Practice location:
  • Phone: 859-257-1000
  • Fax:
Mailing address:
  • Phone: 859-979-1698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number3008730
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License Number3008730
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: