Provider Demographics
NPI:1104615095
Name:BLACKWELL, CASEY
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:BLACKWELL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4050 UNION HWY
Mailing Address - Street 2:
Mailing Address - City:GAFFNEY
Mailing Address - State:SC
Mailing Address - Zip Code:29340-6157
Mailing Address - Country:US
Mailing Address - Phone:864-619-6263
Mailing Address - Fax:
Practice Address - Street 1:4050 UNION HWY
Practice Address - Street 2:
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29340-6157
Practice Address - Country:US
Practice Address - Phone:864-619-6263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider