Active NPI
Michaela Blackwell, AUD
- Audiologist
- Wilkes Barre, PA
National Provider Identifier
1063303113
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Audiologist
- License
- AT007058
- Practice address
- 950 E Mountain Blvd
Wilkes Barre, PA 18711-0028 - Phone
- (570) 808-7923
- NPI assigned
- Jul 15, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Audiologist | 231H00000X | AT007058 | PA | Primary |
Addresses
Primary practice location
950 E Mountain Blvd
Wilkes Barre, PA 18711-0028
Mailing address
950 E Mountain Blvd
Wilkes Barre, PA 18711-0028
Phone (570) 484-1235
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AT007058 | PA | MD | Audiologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1752537600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1771545600000",
"number": "1063303113",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "950 E MOUNTAIN BLVD",
"city": "WILKES BARRE",
"state": "PA",
"postal_code": "187110028",
"telephone_number": "570-484-1235"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "950 E MOUNTAIN BLVD",
"city": "WILKES BARRE",
"state": "PA",
"postal_code": "187110028",
"telephone_number": "570-808-7923"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACKWELL",
"first_name": "MICHAELA",
"name_prefix": "Dr.",
"credential": "AUD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-07-15",
"last_updated": "2026-02-20",
"certification_date": "2026-02-20",
"status": "A"
},
"taxonomies": [
{
"code": "231H00000X",
"taxonomy_group": "",
"desc": "Audiologist",
"state": "PA",
"license": "AT007058",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wilkes Barre, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.