Individual ProviderWehti BlackledgeNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address15459 Annapolis Rd, Bowie, MD 20715-1847(240) 544-0676(804) 968-5700PECOS EnrollmentBased on the most recent information from CMS, provider Wehti Blackledge is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records today at 9:43 AM.Profile DetailsProvider ID1760767735Provider TypeIndividualFull NameBlackledge, WehtiGenderFemaleSole ProprietorNoEnumeration Date10/20/2011Last Updated2/11/2021Contact InformationPractice LocationPractice Address15459 Annapolis Rd, Bowie, MD 20715-1847Phone(240) 544-0676FaxUnlisted FaxMailing LocationMailing Address5000 Cox Rd, Glen Allen, VA 23060-9263Phone(804) 968-5700FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363LF0000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicenseR166525MarylandCode363LF0000XDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense1025280District of Columbia