Derrick Blackburn
Individual provider Active NPI Day Training/Habilitation Specialist · Fairbanks, AK
NPI 1104663715 · NPPES record last updated Jul 10, 2024
Key facts
- NPI
- 1104663715
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Day Training/Habilitation Specialist 373H00000X
- Practice address
- 909 Cushman St Ste 103
Fairbanks, AK 99701-4668 - Phone
- (907) 456-4620
- NPI assigned
- Jul 10, 2024
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Manager/Care Coordinator | 171M00000X | |||
| Chore Provider | 372500000X | |||
| Adult Companion | 372600000X | |||
| Day Training/Habilitation Specialist | 373H00000X | Yes |
Addresses
Primary practice location
909 Cushman St Ste 103
Fairbanks, AK 99701-4668
Mailing address
909 Cushman St Ste 103
Fairbanks, AK 99701-4668
Phone (907) 456-4620
Other providers in Fairbanks, AK
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- Birch Tree Counseling LLC
- Amber T Bird
- George Gregory Bird
- Emma Faith Birkholz
- Karen R Blackburn
- Wendy Ann Blackwell
- Candace Alexis Blackwood
- Ryan Blair
- Kendrick David Blais
All providers in Fairbanks, AK · Day Training/Habilitation Specialist in Alaska
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 10, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.