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

Kory Blackwell

Individual provider Family Medicine Physician · NPI 1255751525

Kory Blackwell is a Family Practice in Hattiesburg, Mississippi. Graduated from University of Mississippi School of Medicine in 2014, 12 years ago. Practices with Hattiesburg Clinic PA, a 530-clinician group and accepts Medicare assignment. Licensed in Mississippi.

Years since qualifying
12
Trained at
University of Mississippi School of Medicine
Licensed in
MS
In the registry since
2014
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Practice location Address checks out

5192 Old Highway 11 Ste 2
Hattiesburg, MS 39402-6222
Phone: (601) 268-0929
Fax: (601) 261-0508
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence 24444 (MS)

Record details

NPI number1255751525
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedApril 24, 2014
Last updated in NPPESJanuary 7, 2021
Certification dateJanuary 7, 2021
Mailing address415 South 28th Avenue, Hattiesburg, MS 39401

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyFAMILY PRACTICE
Medical schoolUNIVERSITY OF MISSISSIPPI SCHOOL OF MEDICINE
Graduated 2014 (12 years in practice)
Group practice Hattiesburg Clinic Pa — 530 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Hattiesburg