Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Kalob Michael Blackwell, PA-C

Individual provider Medical Physician Assistant · NPI 1710805973

Kalob Michael Blackwell, PA-C is a Medical Physician Assistant in Shawnee, Oklahoma. Works from 4 locations. Licensed in Oklahoma.

Licensed in
OK
In the registry since
2026
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

4409 N Kickapoo Ave
Shawnee, OK 74804-1206
Phone: (405) 242-4100
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (3)

  • 4023 N Flood Ave, Norman, OK 73069-8354 — (405) 242-4100
  • 3601 Nw 138th St Ste 200, Oklahoma City, OK 73134-2513 — (405) 242-4100
  • 1703 Professional Cir Ste 101, Yukon, OK 73099-6497 — (405) 242-4100

Specialties & licences

Medical Physician Assistant (primary) Taxonomy 363AM0700X · Licence 6206 (OK)

Record details

NPI number1710805973
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedJuly 7, 2026
Last updated in NPPESJuly 9, 2026
Certification dateJuly 9, 2026

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