Healthcare Provider Details

I. General information

NPI: 1437014883
Provider Name (Legal Business Name): HALEY BLACKBURN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

1513 HARRISON AVE STE A2
ELKINS WV
26241-4514
US

IV. Provider business mailing address

12 MAIN ST
BEVERLY WV
26253-9707
US

V. Phone/Fax

Practice location:
  • Phone: 304-242-8404
  • Fax:
Mailing address:
  • Phone: 681-280-0174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: