NANCI JACQULYN SULLIVAN-BLACKERT RN MSN CDE NP-C NPI 1568718336

NPI Information

NPI: 1568718336
Provider Name: NANCI JACQULYN SULLIVAN-BLACKERT, RN, MSN, CDE, NP-C
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Individual

Specialization: Family

PECOS Registration: Yes

Address:
3604 BUSH ST
RALEIGH, NC
ZIP 27609
Phone: (919) 876-7807
Get Directions

Nanci Jacqulyn Sullivan-blackert, RN, MSN, CDE, NP-C is a family nurse practitioner in Raleigh, NC. Nanci Jacqulyn Sullivan-blackert, RN, MSN, CDE, NP-C NPI is 1568718336. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

3604 BUSH ST
RALEIGH, NC
ZIP 27609-511
Phone: (919) 876-7807
Fax: (919) 459-8402

The NPI 1568718336 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Power Mobility Devices.

The enumeration date for this NPI number is 7/31/2012 and was last updated on 8/11/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LF0000X	Nurse Practitioner	Family	F0512372	NORTH CAROLINA	No
2	363LF0000X	Nurse Practitioner	Family	5005832	NORTH CAROLINA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1568718336	OTHER		HNFS/TRICARE
2	FH4001480	OTHER	NORTH CAROLINA	FIRST MEDICARE DIRECT
3	NCD181B	MEDICARE PIN	NORTH CAROLINA
4	1568718336	MEDICAID	NORTH CAROLINA
5	FH4001480	OTHER	NORTH CAROLINA	FIRST CAROLINA CARE, INC

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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