Provider Demographics
NPI:1144467002
Name:BLACKBURN, NAOMI KAY (RN, CNP)
Entity type:Individual
Prefix:
First Name:NAOMI
Middle Name:KAY
Last Name:BLACKBURN
Suffix:
Gender:F
Credentials:RN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23030 STATE ROUTE 73
Mailing Address - Street 2:
Mailing Address - City:WEST PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45663-8861
Mailing Address - Country:US
Mailing Address - Phone:740-858-1063
Mailing Address - Fax:740-858-9140
Practice Address - Street 1:23030 STATE ROUTE 73
Practice Address - Street 2:
Practice Address - City:WEST PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45663-8861
Practice Address - Country:US
Practice Address - Phone:740-858-1063
Practice Address - Fax:740-858-9140
Is Sole Proprietor?:No
Enumeration Date:2009-01-14
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN241001363LF0000X
OHCOA.10506-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100086520Medicaid
1003908930OtherFACILITY NPI #
OH2954272Medicaid
OHRN241001OtherLICENSE NUMBER
1003908930OtherFACILITY NPI #