Provider Demographics
NPI:1427822378
Name:BLACKBURN, ASHLEY (CRNP)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:BLACKBURN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1903 MORGANTOWN RD
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19607-9620
Mailing Address - Country:US
Mailing Address - Phone:610-777-4040
Mailing Address - Fax:610-777-5575
Practice Address - Street 1:1903 MORGANTOWN RD
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19607-9620
Practice Address - Country:US
Practice Address - Phone:610-777-4040
Practice Address - Fax:610-777-5575
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-10
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP028633207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty