| Rickey Allen Blackburn Jr, CRNP | |
|
102 Edwina St, Evergreen, AL 36401-3319 | |
| (251) 578-0220 | |
| (251) 578-0223 |
| Full Name | Rickey Allen Blackburn Jr |
|---|---|
| Gender | Male |
| Speciality | Nurse Practitioner - Family |
| Location | 102 Edwina St, Evergreen, Alabama |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841715430 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363LF0000X | Nurse Practitioner - Family | 1-131157 (Alabama) | Primary |
| Entity Name | Evergreen Medical Center Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1619559812 PECOS PAC ID: 6305942145 Enrollment ID: O20230908000297 |
| Mailing Address | Practice Location Address |
|---|---|
| Rickey Allen Blackburn Jr, CRNP 102 Edwina St, Evergreen, AL 36401-3319 Ph: (251) 578-0220 | Rickey Allen Blackburn Jr, CRNP 102 Edwina St, Evergreen, AL 36401-3319 Ph: (251) 578-0220 |
Jessica Roberts Pierce, NP-C Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 106 Edwina Street, Evergreen, AL 36401 Phone: 251-578-4300 Fax: 251-578-4307 | |
Chelsey Pettis, Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 100 Edwina St, Evergreen, AL 36401 Phone: 251-578-0278 Fax: 251-578-1055 | |
Mrs. Lisa Marie Ripple, CRNP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 101 Crestview Ave, Evergreen, AL 36401 Phone: 251-578-0176 | |
Mrs. Haley Nobles Falkenberry, Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: Evergreen Family Health Center, 316 S. Main St, Evergreen, AL 36401 Phone: 251-578-2507 Fax: 251-578-3668 |