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General NPI Number Information
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NPI Number | 1487197232
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Entity Type | Individual
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Provider Name | MRS. CODY BLACKMON
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Gender | Female
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Dates
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Enumeration Date | 11/28/2016
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 9901 N MAY AVE STE 110
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City | OKLAHOMA CITY
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State | OK
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Zip | 73120-2734
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Country | US
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Telephone | 405-849-5624
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Fax |
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Provider Business Mailing Address
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Address Line | 538 HIWASSEE DR
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City | DECATUR
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State | TN
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Zip | 37322-6033
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Country | US
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Telephone | 405-406-7977
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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 | 163WL0100X
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Taxonomy Name | Lactation Consultant (Registered Nurse)
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License Number | 272468
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License Number State | TN
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