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KENNETH TODD BLACKNER M.D.
NPI 1043339641
General Practice in Shelley, ID

Active since March 28, 2007
275 W LOCUST ST, SHELLEY, ID 83274(208) 357-3960 Get Directions Write a Review

NPPES record last updated: February 3, 2016. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Kenneth Todd Blackner M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KENNETH TODD BLACKNER M.D. (NPI 1043339641) is an individual general practice provider in Shelley, Idaho, licensed in Idaho (M-11785) and active in the NPI registry since March 2007.

NPPES Registry Identity

NPI1043339641
Entity TypeIndividualMale
Primary Taxonomy208D00000X
Provider Legal NameKENNETH TODD BLACKNERCredential: M.D.
Location Address275 W LOCUST STShelley, ID 83274-1230
Mailing Address618 E 1450 NShelley, ID 83274-5078 · (757) 617-3339
Phone(208) 357-3960
Sole ProprietorYes
Enumeration DateMarch 28, 2007
Last NPPES UpdateFebruary 3, 2016
✔ NPI 1043339641 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyGeneral PracticeAllopathic & Osteopathic Physicians
Taxonomy Code208D00000X
Licenses✔ Licensed in ID · M-11785✔ Licensed in VA · 0101240258
Definition
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee
275 W LOCUST ST, Shelley, ID 83274
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Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

BMH INC
Clinic/Center (Rural Health)
275 W LOCUST ST
SHELLEY, ID 83274
Bingham County (208) 782-2960
BINGHAM MEMORIAL HOSPITAL
Clinic/Center (Rural Health)
275 W LOCUST ST
SHELLEY, ID 83274
Bingham County (208) 785-4100

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kenneth Blackner's NPI number?

The NPI number for Kenneth Blackner is 1043339641. It was assigned to this individual provider in the NPPES registry on March 28, 2007.

Where is Kenneth Blackner located?

Kenneth Blackner practices at 275 W Locust St, Shelley, ID 83274. The listed phone number is (208) 357-3960.

What is Kenneth Blackner's specialty?

The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.

When was this NPI record last updated?

The NPPES record for Kenneth Blackner was last updated on February 3, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.