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Contact Information

BLEN D BLACKWELL, PA-C
3688 VETERANS MEMORIAL DR.
SUITE 200
HATTIESBURG, MS39401
 Phone: 601-554-7400
 Fax: 601-554-7499
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Physician Assistant

363A00000X 97 Physician Assistant
Indicates primary specialty

NPI Profile & details for BLEN D BLACKWELL · (Male)

NPI Number 1811217409
Status Active
Credentials PA-C (Physician Assistant-Certified)
Entity Individual
Enumeration date 06/04/2010
Last updated 08/20/2013 - About 13 years ago
Sole proprietor 1 No
Identifiers
  • MS License # PA00132
Hospital affiliation(s)
  • FORREST GENERAL HOSPITAL - (Acute Care)
    6051 US HIGHWAY 49
    HATTIESBURG, MS 39404
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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