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

Individual provider Medical Physician Assistant · NPI 1790158392

Mrs. Brandy Blackston, PA-C is a Physician Assistant in Berkley, Michigan. Qualified in 2015, 11 years ago. Practices with Beaumont Medical Group- Specialty Services, a 858-clinician group, works from 2 locations, accepts Medicare assignment and offers telehealth. Licensed in Michigan.

Years since qualifying
11
Licensed in
MI
In the registry since
2015
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

27901 Woodward Ave Ste 300
Berkley, MI 48072-0921
Phone: (248) 545-0070
Fax: (248) 545-4850
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 16800 W 12 Mile Rd Ste 102, Southfield, MI 48076-6335 — (248) 569-9797

Specialties & licences

Medical Physician Assistant (primary) Taxonomy 363AM0700X · Licence 5601007562 (MI)

Record details

NPI number1790158392
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorYes
NPI enumeratedNovember 4, 2015
Last updated in NPPESJuly 22, 2022
Certification dateJuly 22, 2022

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2015 (11 years in practice)
Group practice Beaumont Medical Group- Specialty Services — 858 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations4 on file with Medicare

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