Provider Demographics
NPI:1295944502
Name:BLACKWELDER, KAREN H (PA-C)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:H
Last Name:BLACKWELDER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:3475 LAKELAND RD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-8720
Mailing Address - Country:US
Mailing Address - Phone:704-786-9450
Mailing Address - Fax:704-687-3221
Practice Address - Street 1:9201 UNIVERSITY CITY BLVD
Practice Address - Street 2:UNC CHARLOTTE STUDENT HEALTH CENTER
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28223-0001
Practice Address - Country:US
Practice Address - Phone:704-687-4793
Practice Address - Fax:704-687-3221
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC102704363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2752907Medicare ID - Type Unspecified
NCP10985Medicare UPIN