CAROLYN ANN BLACKBURN FNP-C NPI 1902336431

NPI Information

NPI: 1902336431
Provider Name: CAROLYN ANN BLACKBURN, FNP-C
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Individual

Specialization: Family

Organization: NORTHWEST HEALTH SERVICES INC

PECOS Registration: Yes

Address:
109 N MAIN ST
BRAYMER, MO
ZIP 64624
Phone: (660) 645-2218
Get Directions

Carolyn Ann Blackburn, FNP-C is a family nurse practitioner in Braymer, MO with 7 years of experience. Carolyn Ann Blackburn, FNP-C NPI is 1902336431. 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:

109 N MAIN ST
BRAYMER, MO
ZIP 64624-325
Phone: (660) 645-2218
Fax: (660) 645-2820

The NPI 1902336431 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 6/18/2017 and was last updated on 11/16/2021.

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	163W00000X	Registered Nurse		2008017992	MISSOURI	No
2	363LF0000X	Nurse Practitioner	Family	2017032960	MISSOURI	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	420047801	MEDICAID	MISSOURI

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: 11/14/2023

NPI Synchronization or Removal

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