Provider Demographics
NPI:1699930628
Name:BLACKBURN, MARY ZOE (RN, CNS-MS-BC)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:ZOE
Last Name:BLACKBURN
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Gender:F
Credentials:RN, CNS-MS-BC
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Mailing Address - Street 1:2501 W WILLIAM CANNON DR
Mailing Address - Street 2:SUITE 401
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-5281
Mailing Address - Country:US
Mailing Address - Phone:512-416-7246
Mailing Address - Fax:512-275-2833
Practice Address - Street 1:351 CYPRESS CREEK RD
Practice Address - Street 2:SUITE 201
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-4528
Practice Address - Country:US
Practice Address - Phone:512-416-7246
Practice Address - Fax:512-275-2833
Is Sole Proprietor?:No
Enumeration Date:2008-07-18
Last Update Date:2021-07-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXAP111190364S00000X, 364SM0705X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No364SM0705XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX207705903Medicaid
TX207705904Medicaid
TX207705903Medicaid
TXTXB149521Medicare PIN
TXTXB149751Medicare PIN