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General NPI Number Information
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NPI Number | 1023168358
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Entity Type | Individual
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Provider Name | JACQUELYN A BLACKSTONE DO
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Gender | Female
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 10/29/2025
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Provider Practice Location Address
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Address Line | 4701 MONTGOMERY BLVD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-1219
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Country | US
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Telephone | 505-727-6853
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Fax |
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Provider Business Mailing Address
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Address Line | 4101 INDIAN SCHOOL RD NE STE 110
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-3991
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VM0101X
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Taxonomy Name | Maternal & Fetal Medicine Physician
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License Number | A-1954-16
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License Number State | NM
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