Active NPI
Ken Blackburn
- Rehabilitation Practitioner
- Sparks, NV
National Provider Identifier
1699084608
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rehabilitation Practitioner
- Practice address
- 480 Galletti Way
Sparks, NV 89431-5564 - Phone
- (775) 333-0943
- NPI assigned
- Sep 26, 2010
- Last updated
- Sep 26, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rehabilitation Practitioner | 225400000X | NU | Primary |
Addresses
Primary practice location
480 Galletti Way
Sparks, NV 89431-5564
Mailing address
7491 Ambush CT
Sparks, NV 89436-7459
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0 | Medicaid | NV |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1285459200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1285459200000",
"number": "1699084608",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7491 AMBUSH CT",
"city": "SPARKS",
"state": "NV",
"postal_code": "894367459"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "480 GALLETTI WAY",
"city": "SPARKS",
"state": "NV",
"postal_code": "894315564",
"telephone_number": "775-333-0943"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACKBURN",
"first_name": "KEN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-09-26",
"last_updated": "2010-09-26",
"status": "A"
},
"taxonomies": [
{
"code": "225400000X",
"taxonomy_group": "",
"desc": "Rehabilitation Practitioner",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sparks, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.