MEDICARE: ERICA BLACKBURN RDN

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	133V00000X	Registered Dietitian	86144504	NC

General Provider Information

NPI Number	:	1952979734
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA BLACKBURN RDN

Provider Business Mailing Address
First Line	:	1734 SILVER RUN CT
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27127-5767
Country	:	US
Telephone Number	:	917-865-9447
Fax Number	:

Provider Business Practice Location Address
First Line	:	1734 SILVER RUN CT
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27127-5767
Country	:	US
Telephone Number	:	917-865-9447
Fax Number	:

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

Provider Enumeration Date	:	06/16/2021
Last Update Date	:	02/12/2026

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