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NPI Code Detail

MEDICARE: ASHLIN BLACKMON

MEDICARE: ASHLIN BLACKMON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LA2100XAcute Care Nurse Practitioner30862SC
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1124916390
Entity Type Code : Individual
Provider Name (Legal Business Name) : ASHLIN BLACKMON
Provider Business Mailing Address
First Line : PO BOX 6069
Second Line :
City : WEST COLUMBIA
State : SC
Zip : 29171-6069
Country : US
Telephone Number : 803-936-7372
Fax Number : 803-936-4102
Provider Business Practice Location Address
First Line : 2720 SUNSET BLVD
Second Line :
City : WEST COLUMBIA
State : SC
Zip : 29169-4810
Country : US
Telephone Number : 803-791-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/26/2025
Last Update Date : 03/18/2026

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Directions to “ ASHLIN BLACKMON ” Practice Location

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