Taiyonna Marshea Lynnese Blackmon, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

2020033205 Issued in MO

Practice address

4577 Carter Ave
Saint Louis, MO 63115-2516

Phone

(314) 410-9117

NPI assigned

Aug 2, 2024

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ultimate Dream Healthcare LLC

  • Licensed Practical Nurse
  • Saint Louis, MO
  • NPI 1396626842
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1722556800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722556800000",
    "number": "1033949243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4577 CARTER AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631152516",
            "telephone_number": "314-410-9117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4577 CARTER AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631152516",
            "telephone_number": "314-410-9117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKMON",
        "first_name": "TAIYONNA",
        "middle_name": "MARSHEA LYNNESE",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-08-02",
        "last_updated": "2024-08-02",
        "certification_date": "2024-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "MO",
            "license": "2020033205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Megan Elizabeth Blackburn
• Sally Blackburn, LPC
• Jannah D Blackmon
• Jessica Blackmon, OT
• Kailyn Blackmon, PSYD
• Blackmun Footcare LLC
• Carol D Blacksher, APRN BC
• Blackwell & Roscoe Autism Spectrum Intervention Partners, Inc.
• Allison Blackwell
• Anita Jane Blackwell, RNCPNP

• Licensed Practical Nurse in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Licensed Practical Nurse in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.