Jessica Blackwill, APRN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

53-78792-101 Issued in KS

Practice address

750 W D Ave
Kingman, KS 67068-1266

Phone

(620) 532-0295

Fax

(855) 483-0002

NPI assigned

May 29, 2019

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

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in KS

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.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ninnescah Valley Health Systems Inc 11 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Kingman Healthcare Center Hospital, Kingman, KS, CCN 171378

Merit-based Incentive Payment System (MIPS)

Final score

87.31 of 100Reported as group

Quality

76.94

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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 and National Provider Directory roles.

• Ninnescah Valley Health Systems, Inc.

  • Critical Access Hospital
  • Kingman, KS
  • NPI 1285629956

  KS

  Medicare reassignment Care Compare group NPD
• Ninnescah Valley Health Systems, Inc.

  • Critical Access Hospital
  • Kingman, KS
  • NPI 1508969965

  KS

  Medicare reassignment Care Compare group NPD
• Ninnescah Valley Health Systems Inc

  • Rural Health Clinic/Center
  • Cunningham, KS
  • NPI 1437542073
  Care Compare group NPD
• Ninnescah Valley Health Systems Inc

  • Rural Health Clinic/Center
  • Kingman, KS
  • NPI 1508253501
  Care Compare group NPD
• Ninnescah Valley Health Systems, Inc.

  • Medicare Defined Swing Bed Hospital Unit
  • Kingman, KS
  • NPI 1528026291
  Care Compare group

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Ninnescah Valley Health Systems, Inc.

  • Critical Access Hospital
  • Kingman, KS
  • NPI 1285629956

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1559088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756857600000",
    "number": "1114584802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "750 W D AVE",
            "city": "KINGMAN",
            "state": "KS",
            "postal_code": "670681266",
            "telephone_number": "620-532-0295",
            "fax_number": "855-483-0002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 W D AVE",
            "city": "KINGMAN",
            "state": "KS",
            "postal_code": "670681266",
            "telephone_number": "620-532-0295",
            "fax_number": "855-483-0002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKWILL",
        "first_name": "JESSICA",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-29",
        "last_updated": "2025-09-03",
        "certification_date": "2025-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "KS",
            "license": "53-78792-101",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30003916630006",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201243020A",
            "state": "KS"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jessica.blackwill.1@19447.direct.athenahealth.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "760 W D Ave",
            "city": "Kingman",
            "state": "KS",
            "country_code": "US",
            "postal_code": "670681222",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Tyler J Antenen, P.A.-C
• Aspire Physical Therapy Inc
• Erin M Baxa, MD
• Randall Renee Beech, MD
• Laura C Bevis, ARNP
• Lisa Boyle, PTA
• Cancer Center of Kansas, P.a.
• Christopher H Surtman DPM LLC
• City of Kingman
• County of Kingman

• All providers in Kingman, KS
• Family Nurse Practitioner in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2025; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.