Healthcare Provider Details

I. General information

NPI: 1225618713
Provider Name (Legal Business Name): BLACKWELL NURSING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2021
Last Update Date: 04/09/2021
Certification Date: 04/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 CLAIRMONT CIRCLE
LAUREL MS
39440
US

IV. Provider business mailing address

PO BOX 2276
LAUREL MS
39442
US

V. Phone/Fax

Practice location:
  • Phone: 601-342-2021
  • Fax: 601-342-2714
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name: KEVIN SMITH
Title or Position: OWNER
Credential:
Phone: 601-342-2021