Provider Demographics
NPI:1316735103
Name:BLACKBURN, KALEY JADE
Entity type:Individual
Prefix:
First Name:KALEY
Middle Name:JADE
Last Name:BLACKBURN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 FOREST HILLS RD
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41527-8308
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:455 FOREST HILLS RD
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:KY
Practice Address - Zip Code:41527-8308
Practice Address - Country:US
Practice Address - Phone:304-733-1094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant