Healthcare Provider Details

I. General information

NPI: 1568745966
Provider Name (Legal Business Name): NORALYN CHRISTINA BLALOCK-PERKINS F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2011
Last Update Date: 11/16/2022
Certification Date: 11/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

557 GRANTS FERRY RD
BRANDON MS
39047-9023
US

IV. Provider business mailing address

36 PEMBERTON CV
JACKSON TN
38305-5514
US

V. Phone/Fax

Practice location:
  • Phone: 601-665-4162
  • Fax: 855-830-3484
Mailing address:
  • Phone: 731-394-1145
  • Fax: 844-374-0233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number867899
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: