Nataiya Blackmon
Individual provider Active NPI Meals Provider · Rolla, MO
NPI 1134040199 · NPPES record last updated Jul 23, 2026
Key facts
- NPI
- 1134040199
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Meals Provider 174200000X
- Practice address
- 1106 Laguille CT
Rolla, MO 65401-3440 - Phone
- (948) 204-0694
- NPI assigned
- Jul 23, 2026
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Meals Provider | 174200000X | Yes |
Addresses
Primary practice location
1106 Laguille CT
Rolla, MO 65401-3440
Mailing address
1106 Laguille CT
Rolla, MO 65401-3440
Phone (948) 204-0694
Other providers in Rolla, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 23, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.