Provider Demographics
NPI:1720835168
Name:BLACKMON, MERCEDES MARTHA (RN)
Entity type:Individual
Prefix:
First Name:MERCEDES
Middle Name:MARTHA
Last Name:BLACKMON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 AUGUSTUS LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOLLY
Mailing Address - State:NC
Mailing Address - Zip Code:28120-7714
Mailing Address - Country:US
Mailing Address - Phone:810-334-8043
Mailing Address - Fax:
Practice Address - Street 1:613 AUGUSTUS LN
Practice Address - Street 2:
Practice Address - City:MOUNT HOLLY
Practice Address - State:NC
Practice Address - Zip Code:28120-7714
Practice Address - Country:US
Practice Address - Phone:810-334-8043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC321655163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical