Healthcare Provider Details

I. General information

NPI: 1144135898
Provider Name (Legal Business Name): TAYLOR BROOKE BLACKBURN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 SW CENTER ST
FAISON NC
28341-8820
US

IV. Provider business mailing address

11696 GARLAND HWY
CLINTON NC
28328-7186
US

V. Phone/Fax

Practice location:
  • Phone: 910-267-0421
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number5025230
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: