Provider Demographics
NPI:1033618848
Name:BLACKWELL, MACY (FNP)
Entity type:Individual
Prefix:
First Name:MACY
Middle Name:
Last Name:BLACKWELL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2340 SPRING FOREST RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-7528
Mailing Address - Country:US
Mailing Address - Phone:866-389-2727
Mailing Address - Fax:
Practice Address - Street 1:2340 SPRING FOREST RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-7528
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1139819363LF0000X
AL1-202347363LF0000X
WI15711-33363LF0000X
WV120172363LF0000X
ND200002363LF0000X
GAGAA-NP002406363LF0000X
NJ26NJ15215300363LF0000X
SC28987363LF0000X
VA0024189077363LF0000X
CT13428363LF0000X
SDCP003289363LF0000X
PASP032073363LF0000X
NY355704363LF0000X
NC5010262363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily