Basic Information
| Provider Information | |||||||||
| NPI: | 1174294227 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BLACKBURN | ||||||||
| FirstName: | DONALD | ||||||||
| MiddleName: | EDWARD | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7818 PEAR VIEW LN | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402184761 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025525512 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2000 RING RD | ||||||||
| Address2: | |||||||||
| City: | ELIZABETHTOWN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 427019454 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2705062730 | ||||||||
| FaxNumber: | 2709000704 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2021 | ||||||||
| LastUpdateDate: | 10/12/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 3016712 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.