Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Derrick Blackburn

Individual provider Case Manager/Care Coordinator · NPI 1104663715

Derrick Blackburn is a Case Manager/Care Coordinator in Fairbanks, Alaska. Registered with an NPI since 2024.

In the registry since
2024
Specialties on file
4

Practice location Address checks out

909 Cushman St Ste 103
Fairbanks, AK 99701-4668
Phone: (907) 456-4620
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Day Training/Habilitation Specialist (primary) Taxonomy 373H00000X
Case Manager/Care Coordinator Taxonomy 171M00000X
Chore Provider Taxonomy 372500000X
Adult Companion Taxonomy 372600000X

Record details

NPI number1104663715
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedJuly 10, 2024
Last updated in NPPESJuly 10, 2024
Certification dateJuly 10, 2024
Mailing address909 Cushman St Ste 103, Fairbanks, AK 99701-4668

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