IndividualActive
Charla Blackwell
NPI 1508711904 · Child & Adolescent Psychiatric/Mental Health Registered Nurse · Brandon, MS
Provider details
- NPI number
- 1508711904
- Entity type
- Individual
- Primary specialty
- Child & Adolescent Psychiatric/Mental Health Registered NurseNursing Service Providers
- Sex
- Female
- Sole proprietor
- No
- License
- 883208 (MS)
Specialties & taxonomies
Nursing Service Providers
Practice location
613 Marquette Rd
Brandon, MS 39042-3038
Phone: (601) 824-1692
Approximate (ZIP-level) locationGet directions
Mailing address
128 Willow Crest Cir
Brandon, MS 39047-7064
Registry dates
- Enumerated
- 2026-03-02
- Last updated
- 2026-03-02
- Certified
- 2026-03-02
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.