Individual provider · NPI-1

Scott Anthony Blackburn, NP

Nurse Practitioner, Primary Care · Southgate, MI

NPI number1003554494

StatusActive

Last updated in NPPESJul 21, 2026

Details

NPI: 1003554494
Entity type: Individual (NPI-1)
Name: Scott Anthony Blackburn
Credential: NP
Sex: Male
Sole proprietor: No
Enumeration date: May 25, 2022
Certification date: Jul 21, 2026
Last updated: Jul 21, 2026

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
363LP2300X	Nurse Practitioner, Primary Care	4704326782	MI	Yes

Practice location

11275 Allen Rd
Southgate, MI 48195-3380

Phone 313-383-7071 · Fax 313-383-7194

Mailing address

11275 Allen Rd
Southgate, MI 48195-3380

Phone 313-383-7071 · Fax 313-383-7194

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