Glenn Koontz Blackburn Jr., M.D.

Primary specialty

Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X

License

16207 Issued in KY

Practice address

Children'S Clinic
350 Langdon St.
Somerset, KY 42503

Phone

(606) 678-8155

Fax

(606) 678-7548

NPI assigned

Jan 26, 2006

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1138233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1750351037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "CHILDREN'S CLINIC",
            "address_2": "350 LANGDON ST.",
            "city": "SOMERSET",
            "state": "KY",
            "postal_code": "42503",
            "telephone_number": "606-678-8155",
            "fax_number": "606-678-7548"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CHILDREN'S CLINIC",
            "address_2": "350 LANGDON ST.",
            "city": "SOMERSET",
            "state": "KY",
            "postal_code": "42503",
            "telephone_number": "606-678-8155",
            "fax_number": "606-678-7548"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKBURN",
        "first_name": "GLENN",
        "middle_name": "KOONTZ",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-26",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "KY",
            "license": "16207",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64162076",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Heather Susanne Bishop
• Ladonya Allison Bishop, RPH
• Colleen Bivens, LCSW
• Judy Black
• Brandi Nicole Blackburn, M.D.
• Kelsey Blaha, LPCC
• Andrew Blakley
• Rebecca Jeannine Blakley, CPNP
• Erin Blasko
• Blaze Valley Corporation

• Pediatric Adolescent Medicine Physician in Somerset, KY
• Providers in Somerset, KY by specialty
• Pediatric Adolescent Medicine Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; 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.