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NPI Code Detail

MEDICARE: JENNIFER BLACKWELL MPAS, PA-C

MEDICARE: JENNIFER BLACKWELL MPAS, PA-C
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
1363AM0700XMedical Physician AssistantPA.0006063CO
2363AM0700XMedical Physician Assistant239153AK
3363A00000XPhysician Assistant239153AK
4363AM0700XMedical Physician AssistantPA8212MA

General Provider Information

NPI Number : 1558733493
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER BLACKWELL MPAS, PA-C
Provider Business Mailing Address
First Line : 1221 HUFFMAN PARK DR UNIT 111074
Second Line :
City : ANCHORAGE
State : AK
Zip : 99511-0559
Country : US
Telephone Number : 907-891-8327
Fax Number : 907-931-6167
Provider Business Practice Location Address
First Line : 821 N ST STE 102
Second Line :
City : ANCHORAGE
State : AK
Zip : 99501-3285
Country : US
Telephone Number : 907-891-8327
Fax Number : 907-931-6167
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/29/2015
Last Update Date : 06/05/2026

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