Active NPI
Kathryn V Blackwell, D.O.
- Psychiatry Physician
- Bridgeton, NJ
National Provider Identifier
1144489683
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 25MB06373800
- Practice address
- 215 S Burlington Rd
Bridgeton, NJ 08302-3479 - Phone
- (856) 459-8231
- Fax
- (856) 459-8211
- NPI assigned
- Jun 9, 2008
- Last updated
- Jun 9, 2008
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 25MB06373800 | NJ | Primary |
Addresses
Primary practice location
215 S Burlington Rd
Bridgeton, NJ 08302-3479
Mailing address
46 Mohawk TRL
Medford Lakes, NJ 08055-1527
Phone (609) 234-0103
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
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25MB06373800 | NJ | MD | Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Vista Medical Services, Inc. | Psychiatry | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Psychiatry Physician
- Bala Cynwyd, PA
- NPI 1659452027
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1212969600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1212969600000",
"number": "1144489683",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "46 MOHAWK TRL",
"city": "MEDFORD LAKES",
"state": "NJ",
"postal_code": "080551527",
"telephone_number": "609-234-0103",
"fax_number": "856-459-8211"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "215 S BURLINGTON RD",
"city": "BRIDGETON",
"state": "NJ",
"postal_code": "083023479",
"telephone_number": "856-459-8231",
"fax_number": "856-459-8211"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACKWELL",
"first_name": "KATHRYN",
"middle_name": "V",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-06-09",
"last_updated": "2008-06-09",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "NJ",
"license": "25MB06373800",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bridgeton, NJ
- Elizabeth Bevan, LCSW
- Robert Arnold Birdsall, PHARM D
- BKT High Quality Healthcare Agency (Dignity Nursing & Staffing Solutions)
- BKT High Quality Healthcare Agency LLC (Dignity Nursing Solutions)
- Theresa L Black, LPC, NCC, ACS
- Christina Bocco, PHARM.D.
- Boss Dentistry LLC
- Richard Willet Boss Jr., D.M.D.
- Melissa Bott
- Tarrah Bowick, LCSW
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.