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General NPI Number Information
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NPI Number | 1558733493
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Entity Type | Individual
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Provider Name | JENNIFER BLACKWELL MPAS, PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/29/2015
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Last Update Date | 10/01/2025
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Provider Practice Location Address
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Address Line | 4200 LAKE OTIS PKWY STE 303
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City | ANCHORAGE
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State | AK
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Zip | 99508-5226
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Country | US
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Telephone | 907-600-5212
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Fax | 907-600-1026
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Provider Business Mailing Address
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Address Line | 4200 LAKE OTIS PKWY STE 303
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City | ANCHORAGE
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State | AK
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Zip | 99508-5226
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Country | US
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Telephone | 907-600-5212
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Fax | 907-600-1026
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA.0006063
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA8212
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 239153
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License Number State | AK
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