Healthcare Provider Details

I. General information

NPI: 1831604180
Provider Name (Legal Business Name): LAUREN BLACKMON NP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2017
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 WALTER REED RD
FAYETTEVILLE NC
28304-4437
US

IV. Provider business mailing address

1201 WALTER REED RD
FAYETTEVILLE NC
28304-4437
US

V. Phone/Fax

Practice location:
  • Phone: 910-323-4733
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5010101
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: