Provider Demographics
NPI:1356105068
Name:BLACKWELL, CASSIE SHYANNE (FNP-C)
Entity type:Individual
Prefix:
First Name:CASSIE
Middle Name:SHYANNE
Last Name:BLACKWELL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2218 WINDSOR AVE
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-1806
Mailing Address - Country:US
Mailing Address - Phone:865-224-9229
Mailing Address - Fax:
Practice Address - Street 1:2340 KNOB CREEK RD STE 720
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-2977
Practice Address - Country:US
Practice Address - Phone:423-926-6112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-13
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35710363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily