Jennifer Lynn Blacksmith, PH.D

Primary specialty

PsychologistTaxonomy code 103T00000X

License

2017010148 Issued in MO

Practice address

402 W Jefferson St
Kirksville, MO 63501-3407

Phone

(660) 627-2229

NPI assigned

Nov 5, 2015

Last updated

May 10, 2017By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

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

• Northeast Missouri Health Council, Inc.

  dba Northeast Family Health Clinics

  • Federally Qualified Health Center (FQHC)
  • Kirksville, MO
  • NPI 1104829498
  Medicare reassignment NPD
• Northeast Missouri Health Council Inc

  dba Northeast Family Health Annex

  • Psychologist
  • Kirksville, MO
  • NPI 1336679836
  NPD
• Northeast Missouri Health Council Inc

  dba Memphis Community Health Center

  • Internal Medicine Physician
  • Memphis, MO
  • NPI 1881307155
  NPD

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

{
    "created_epoch": "1446681600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1494374400000",
    "number": "1114390598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "402 W JEFFERSON ST",
            "city": "KIRKSVILLE",
            "state": "MO",
            "postal_code": "635013407",
            "telephone_number": "660-627-2229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "402 W JEFFERSON ST",
            "city": "KIRKSVILLE",
            "state": "MO",
            "postal_code": "635013407",
            "telephone_number": "660-627-2229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKSMITH",
        "first_name": "JENNIFER",
        "middle_name": "LYNN",
        "credential": "PH.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-11-05",
        "last_updated": "2017-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "IA",
            "license": "073513",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MO",
            "license": "2017010148",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ann Marie Bibbs, MSN, RN, NP-C
• Jordan Billington
• Heather Rachelle Bird, DO
• Samantha Jane Bishop, M.A., CCC-SLP
• Mindy M Blackford, O.D.
• Jennifer L Blanke, DPT
• Kent James Blanke, DO
• Leah Blaskowski
• Madison Blauer
• Blooming Speech Therapy LLC

• Psychologist in Kirksville, MO
• Providers in Kirksville, MO by specialty
• Psychologist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2017; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.