Healthcare Provider Details

I. General information

NPI: 1831036995
Provider Name (Legal Business Name): THE SKIN INSTITUTE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 ALBEN BARKLEY DR
PADUCAH KY
42001-4402
US

IV. Provider business mailing address

127 ALBEN BARKLEY DR
PADUCAH KY
42001-4402
US

V. Phone/Fax

Practice location:
  • Phone: 270-444-8477
  • Fax: 270-228-4141
Mailing address:
  • Phone: 270-444-8477
  • Fax: 270-228-4141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH ALLEN BLACKMON
Title or Position: OWNER
Credential: MD
Phone: 270-444-8477