Larry Blackburn

Primary specialty

Personal Care AttendantTaxonomy code 3747P1801X

Practice address

1626 W 3Rd Ave
Williamson, WV 25661-3007

Phone

(304) 235-1701

NPI assigned

Nov 18, 2020

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Coalfield Community Action Partnership, Inc. (CM)

  • Case Management Agency
  • Williamson, WV
  • NPI 1508260647
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1605657600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605657600000",
    "number": "1033712443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1406",
            "city": "WILLIAMSON",
            "state": "WV",
            "postal_code": "256611406",
            "telephone_number": "304-235-1701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1626 W 3RD AVE",
            "city": "WILLIAMSON",
            "state": "WV",
            "postal_code": "256613007",
            "telephone_number": "304-235-1701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKBURN",
        "first_name": "LARRY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-11-18",
        "last_updated": "2020-11-18",
        "certification_date": "2020-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "3747P1801X",
            "taxonomy_group": "",
            "desc": "Technician, Personal Care Attendant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tiffiney Shawn Bentley, P.T.,M.S.
• Nancy Bevins, LPCC
• Courtney Leeann Bianco
• Megan Brook Bishop, LPC
• Angela D Blackburn
• Georgennia Blackwell
• Barry J Blair
• Kelli Jo Blair, B.S.
• Nichole Blair
• Deanna Kaylee Blankenship

• All providers in Williamson, WV
• Personal Care Attendant in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.