Provider Demographics
NPI:1871586271
Name:BLACKLEDGE, PATRICIA LOUISE (ARNP MS)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:LOUISE
Last Name:BLACKLEDGE
Suffix:
Gender:F
Credentials:ARNP MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 458
Mailing Address - Street 2:
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-0458
Mailing Address - Country:US
Mailing Address - Phone:641-684-6896
Mailing Address - Fax:641-226-5759
Practice Address - Street 1:1015 N 18TH ST
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:IA
Practice Address - Zip Code:52544-1170
Practice Address - Country:US
Practice Address - Phone:641-684-6896
Practice Address - Fax:641-226-5759
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA097156163W00000X
IAA097156363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA3254342Medicaid
IA36504OtherWELLMARK BCBS OF IA
IA420681060C4OtherJOHN DEERE HEALTH
IAI12182Medicare ID - Type Unspecified
IA3254342Medicaid