Healthcare Provider Details

I. General information

NPI: 1093516718
Provider Name (Legal Business Name): CHYNNA BLACKMON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2025
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

872 KEENEY ST
AKRON OH
44310-2227
US

IV. Provider business mailing address

872 KEENEY ST
AKRON OH
44310-2227
US

V. Phone/Fax

Practice location:
  • Phone: 330-515-6939
  • Fax:
Mailing address:
  • Phone: 330-515-6939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: