Provider Demographics
NPI:1730918848
Name:BLACKERBY, DAVID DILLARD II (CNC)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:DILLARD
Last Name:BLACKERBY
Suffix:II
Gender:M
Credentials:CNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 PIN OAK DR APT 1506
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3032
Mailing Address - Country:US
Mailing Address - Phone:210-238-4873
Mailing Address - Fax:
Practice Address - Street 1:3501 PIN OAK DR APT 1506
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3032
Practice Address - Country:US
Practice Address - Phone:210-238-4873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-29
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
146N00000X, 3747P1801X, 374U00000X, 3747A0650X
TX171W00000X
TX22130577172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
No171W00000XOther Service ProvidersContractor
No172A00000XOther Service ProvidersDriver
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374U00000XNursing Service Related ProvidersHome Health Aide