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General NPI Number Information
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NPI Number | 1265413264
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Entity Type | Individual
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Provider Name | ALICE T BLACKMON PNP-C
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Gender | Female
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Dates
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Enumeration Date | 11/08/2005
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Last Update Date | 12/10/2025
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Provider Practice Location Address
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Address Line | 7323 MARBACH RD STE 104
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City | SAN ANTONIO
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State | TX
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Zip | 78227-1905
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Country | US
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Telephone | 210-645-4305
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Fax | 210-673-1850
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Provider Business Mailing Address
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Address Line | 7323 MARBACH RD STE 104
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City | SAN ANTONIO
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State | TX
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Zip | 78227-1905
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Country | US
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Telephone | 210-674-0257
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Fax | 210-369-9064
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | AP108315
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License Number State | TX
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