Healthcare Provider Details

I. General information

NPI: 1427400217
Provider Name (Legal Business Name): KACIE BLACKWELL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2016
Last Update Date: 05/20/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16052 DOCTORS BLVD
HAMMOND LA
70403-1478
US

IV. Provider business mailing address

16052 DOCTORS BLVD
HAMMOND LA
70403-1478
US

V. Phone/Fax

Practice location:
  • Phone: 985-945-9606
  • Fax: 985-345-9616
Mailing address:
  • Phone: 985-345-9606
  • Fax: 985-345-9616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9262064
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number220442
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: