Kisharra Blackwell

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

190826 Issued in OH

Practice address

1182 Trails Edge Dr
Hubbard, OH 44425-3359

Phone

(330) 391-2522

NPI assigned

Jun 12, 2025

Sex

Female

Sole proprietor

Yes

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 12, 2025.

{
    "created_epoch": "1749686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749686400000",
    "number": "1164317780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1182 TRAILS EDGE DR",
            "city": "HUBBARD",
            "state": "OH",
            "postal_code": "444253359",
            "telephone_number": "330-391-2522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1182 TRAILS EDGE DR",
            "city": "HUBBARD",
            "state": "OH",
            "postal_code": "444253359",
            "telephone_number": "330-391-2522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKWELL",
        "first_name": "KISHARRA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-06-12",
        "last_updated": "2025-06-12",
        "certification_date": "2025-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "OH",
            "license": "190826",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jason Bednar, LPN
• Thomas Beltz, DPT
• Bonnie Ione Bennett, LPC, LICDC
• Lauren Bentley, APRN, FNP-C
• Victor Bernard
• Peter Bottar, D.O.
• Danna Bozick, LSW, NCC, LICDC, CTT
• Braydich Center for Advanced Dentistry
• Braydich Dental Inc
• Mark Peter Braydich, DDS

• All providers in Hubbard, OH
• Licensed Practical Nurse in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.