JO SUSAN OFFUTT-BLACKABY MSN PMHNP NPI 1689063760

NPI Information

NPI: 1689063760
Provider Name: JO SUSAN OFFUTT-BLACKABY, MSN, PMHNP
Classification: Nurse Practitioner - 363LP0808X
Entity Type: Individual

Specialization: Psychiatric/Mental Health

PECOS Registration: Yes

Address:
2006 MAGGIE CT
GREENBRIER, TN
ZIP 37073
Phone: (615) 620-0998
Get Directions

Jo Susan Offutt-blackaby, MSN, PMHNP is a psychiatric/mental health nurse practitioner in Greenbrier, TN. Jo Susan Offutt-blackaby, MSN, PMHNP NPI is 1689063760. 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:

2006 MAGGIE CT
GREENBRIER, TN
ZIP 37073-500
Phone: (615) 620-0998

The NPI 1689063760 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 1/13/2015 and was last updated on 1/4/2024.

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	363LP0808X	Nurse Practitioner	Psychiatric/Mental Health	25460	SOUTH CAROLINA	No
2	364SP0808X	Clinical Nurse Specialist	Psychiatric/Mental Health	19574	TENNESSEE	No
3	363LP0808X	Nurse Practitioner	Psychiatric/Mental Health	19574	TENNESSEE	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	3335	OTHER	SOUTH CAROLINA	MEDICARE
2	421504	MEDICAID	SOUTH CAROLINA

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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