Clydie Blackwell, RN

Primary specialty

Addiction (Substance Use Disorder) Registered NurseTaxonomy code 163WA0400X

License

041165940 Issued in IL

Practice address

505 S 8TH St
East Saint Louis, IL 62201-2919

Phone

(618) 474-7330

NPI assigned

Dec 5, 2023

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

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1701734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701734400000",
    "number": "1063289635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "329 N 81ST ST",
            "city": "CAHOKIA HEIGHTS",
            "state": "IL",
            "postal_code": "622032509",
            "telephone_number": "770-896-0187"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 S 8TH ST",
            "city": "EAST SAINT LOUIS",
            "state": "IL",
            "postal_code": "622012919",
            "telephone_number": "618-474-7330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKWELL",
        "first_name": "CLYDIE",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-12-05",
        "last_updated": "2023-12-05",
        "certification_date": "2023-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WA0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Addiction (Substance Use Disorder)",
            "state": "IL",
            "license": "041165940",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christopher Wayne Barry, LMSW, CRADC
• Virginia L Behrhorst, BC APRN
• Jasmin A Bell
• Theresa M Benassi-Powles, APN CNP
• Estelisa Bevely, RN
• Board of Trustees of Southern Illinois University
• Karen D Boide, PTA
• Carolyn M. Booth, PA
• Amy Boudonck
• Bright Ideas for a Better Tomorrow

• Addiction (Substance Use Disorder) Registered Nurse in East Saint Louis, IL
• Providers in East Saint Louis, IL by specialty
• Addiction (Substance Use Disorder) Registered Nurse in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2023; 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.