Kristi Lynn Blackburn, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

100002703A Issued in IN

Practice address

1700 W Smith Valley Rd # Unityc-1
Greenwood, IN 46142-1599

Phone

(317) 300-4091

NPI assigned

Nov 17, 2021

Sex

Female

Sole proprietor

No

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

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Feb 23, 2022 through Feb 23, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1637107200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637107200000",
    "number": "1093471799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6302 HARMONRIDGE CT",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462782218",
            "telephone_number": "317-550-7292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 W SMITH VALLEY RD # UNITYC-1",
            "city": "GREENWOOD",
            "state": "IN",
            "postal_code": "461421599",
            "telephone_number": "317-300-4091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKBURN",
        "first_name": "KRISTI",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-11-17",
        "last_updated": "2021-11-17",
        "certification_date": "2021-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IN",
            "license": "100002703A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carolyn Bishop
• Mary Kay Bishop, PT
• Joshua Michael Bitner, PHARMD
• Gloria Jean Bjerke, LCSW
• Lee Arnold Bjerke, MSW
• Joy C Blair
• Morgan Blair, RBT
• Joshua Alan Blanchard, PT, LAT
• Philip A. Blaney, M.D.
• Raime Capri Blattner, ACNP-BC

• Physician Assistant in Greenwood, IN
• Providers in Greenwood, IN by specialty
• Physician Assistant in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.