Karen R Blackburn

Primary specialty

Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X

Practice address

909 Cushman St Ste 103
Fairbanks, AK 99701-4668

Phone

(907) 456-4620

Fax

(907) 457-6598

NPI assigned

Jul 20, 2011

Sex

Female

Sole proprietor

Yes

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.

• Northern Hope Center

  • Community/Behavioral Health Agency
  • Fairbanks, AK
  • NPI 1376398180
  NPD Authorized official CASE MANAGER/CARE COORDINATOR
• Adult Learning Programs of Alaska

  • Developmentally Disabled Services Day Training Agency
  • Fairbanks, AK
  • NPI 1346466802
  NPD (past) DAY TRAINING, DEVELOPMENTALLY DISABLED SERVICES

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 10, 2024.

{
    "created_epoch": "1311120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720569600000",
    "number": "1467740779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "122 1ST AVE",
            "address_2": "SUITE 201",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997014803",
            "telephone_number": "907-452-6434",
            "fax_number": "907-457-6598"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "909 CUSHMAN ST STE 103",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997014668",
            "telephone_number": "907-456-4620",
            "fax_number": "907-457-6598"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKBURN",
        "first_name": "KAREN",
        "middle_name": "R",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-07-20",
        "last_updated": "2024-07-10",
        "certification_date": "2024-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171400000X",
            "taxonomy_group": "",
            "desc": "Health & Wellness Coach",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225600000X",
            "taxonomy_group": "",
            "desc": "Dance Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "372500000X",
            "taxonomy_group": "",
            "desc": "Chore Provider",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Birch Tree Counseling LLC
• Amber T Bird
• George Gregory Bird, D.D.S.
• Emma Faith Birkholz
• Derrick Blackburn
• Wendy Ann Blackwell
• Candace Alexis Blackwood, MS
• Ryan Blair
• Kendrick David Blais, D.O.
• Jamie Blalock

• All providers in Fairbanks, AK
• Developmentally Disabled Services Day Training Agency in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2024; 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.