=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376435206
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GABRIELLE BLACKBURN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/16/2025
-----------------------------------------------------
Last Update Date | 07/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1225 US HIGHWAY 60 W
-----------------------------------------------------
City | MOREHEAD
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40351-6827
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-436-8504
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6540 US HIGHWAY 60 W APT 2
-----------------------------------------------------
City | MOREHEAD
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40351-9782
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-436-8504
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------