Denise P Blackburn, APRN, FNP-BC
Individual provider Active NPI Family Nurse Practitioner · Fenton, MO
NPI 1043568280 · NPPES record last updated Aug 20, 2012
Key facts
- NPI
- 1043568280
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 2012021023 (MO)
- Practice address
- 1011 Bowles Ave
Suite G10
Fenton, MO 63026-2395 - Phone
- (314) 965-9980
- Fax
- (314) 965-1127
- NPI assigned
- Aug 20, 2012
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 8
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2012
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Mercy Clinic East Communities
Practice addresses (Care Compare)
851 E 5TH St
Washington, MO 63090-3130
901 Patients 1St Dr
Washington, MO 63090-4700
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20121109000400 | MO | Practitioner - Nurse Practitioner | 5496906901 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 125820 | MO | MD | Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mercy Clinic Surgical Specialists, LLC | Current |
Accepting new patients | |
| Mercy Clinic East Communities | Family | Current |
Accepting new patients |
| Mercy Clinic East Communities | Current |
Accepting new patients | |
| Mercy Clinic Cardiovascular and Thoracic Surgery, LLC | Past | Accepting new patients |
Locations
739 W Springfield Ave
Gerald, MO 63037
Phone (573) 764-3311
1001 Cardwell St
Saint Clair, MO 63077
Phone (636) 629-3300
3844 S Lindbergh Blvd
Ste 160
Saint Louis, MO 63127
Phone (314) 698-2400
621 S New Ballas Rd
Ste 260A
Saint Louis, MO 63141
Phone (314) 251-4772
621 S New Ballas Rd
Ste 3005B
Saint Louis, MO 63141
Phone (314) 251-7070
10012 Kennerly Rd
Ste 202
Saint Louis, MO 63128
Phone (314) 692-2807
1326 S Service Rd W
Ste 30
Sullivan, MO 63080
Phone (314) 543-5999
521 Anwijo Way
Warrenton, MO 63383
Phone (636) 239-7344
901 Patients First Dr
#2500
Washington, MO 63090
851 E 5th St
Ste 108
Washington, MO 63090
Phone (636) 239-4144
851 E 5th St
Ste 328
Washington, MO 63090
Phone (636) 239-1101
901 Patients First Dr
Ste 2000
Washington, MO 63090
Phone (636) 239-7344
Interoperability endpoints
- dblackburn227087@directc.mercy.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 125820 | MO | |
| Family Nurse Practitioner | 363LF0000X | 2012021023 | MO | Yes |
Addresses
Primary practice location
1011 Bowles Ave
Suite G10
Fenton, MO 63026-2395
Mailing address
2124 Martina Dr
Washington, MO 63090-5213
Phone (636) 259-0207
Other providers in Fenton, MO
- Caitlin Berkbigler
- Andrew David Biekert
- Amanda K. Bigler
- Morgan Ashley Biondo
- Joy Nicole Bittle
- Katherine A. Blackburn
- Joseph A. Blaes
- Danielle Rebecca Blake
- April Louise Blandford
- Diane Denise Block
All providers in Fenton, MO · Family Nurse Practitioner in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 20, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.