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General NPI Number Information
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NPI Number | 1417583642
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Entity Type | Individual
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Provider Name | JENNIFER E BLACKMON
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Gender | Female
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Dates
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Enumeration Date | 03/19/2020
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Last Update Date | 02/06/2025
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Provider Practice Location Address
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Address Line | 1325 NE 7TH ST
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City | GRANTS PASS
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State | OR
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Zip | 97526-1358
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Country | US
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Telephone | 541-460-5331
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Fax | 541-460-5165
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Provider Business Mailing Address
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Address Line | 1325 NE 7TH ST
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City | GRANTS PASS
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State | OR
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Zip | 97526-1358
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Country | US
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Telephone | 541-460-5331
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 10016379
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP145410
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License Number State | TX
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