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

Jacob Blackmon, CCP

Individual provider Perfusionist · NPI 1053130930

Jacob Blackmon, CCP is a Perfusionist in Plymouth, Michigan. Licensed in Texas. Registered with an NPI since 2024.

Licensed in
TX
In the registry since
2024

Practice location Address checks out

45211 Helm St
Plymouth, MI 48170
Phone: (480) 777-0900
Fax: (480) 777-1345
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Perfusionist (primary) Taxonomy 242T00000X · Licence 199052 (TX)

Record details

NPI number1053130930
Entity typeIndividual (Type 1)
GenderMale
Credentials CCP
Sole proprietorNo
NPI enumeratedOctober 7, 2024
Last updated in NPPESJune 26, 2026
Certification dateJune 26, 2026
Mailing address45211 Helm St., Plymouth, MI 48170

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