MEDICARE: JENNIFER LEA BLACKBURN APRN

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
1	363LF0000X	Family Nurse Practitioner	3014608	KY

General Provider Information

NPI Number	:	1710502703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER LEA BLACKBURN APRN

Provider Business Mailing Address
First Line	:	10606 HICKORY GROVE DR
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40291-3776
Country	:	US
Telephone Number	:	502-415-2742
Fax Number	:	502-305-4631

Provider Business Practice Location Address
First Line	:	10606 HICKORY GROVE DR
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40291-3776
Country	:	US
Telephone Number	:	502-415-2742
Fax Number	:	502-305-4631

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2020
Last Update Date	:	06/05/2025

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