Jacqueline D. Blanton – Acute Care Nurse Practitioner

Key facts

NPI: 1235300054
Entity type: Individual (NPI type 1)
Primary specialty: Acute Care Nurse Practitioner 363LA2100X
License: 13405 (TN)
Practice address: 1801 N Washington St
Ste. 300
Tullahoma, TN 37388-8245
Phone: (931) 393-4995
Fax: (931) 393-3573
NPI assigned: Mar 19, 2008
Sex: Female
Sole proprietor: No

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 and National Provider Directory roles.

Nephrology Associates, PC Nephrology Physician · Nashville, TN · NPI 1700878360

Medicare reassignment Care Compare group NPD ACUTE CARE · TN

Medicare Care Compare profile

Specialty: Nurse Practitioner
Education: Other, 2007
Medicare assignment: Accepts the Medicare-approved amount as payment in full
Group practices: Nephrology Associates, PC (40 clinicians)

Practice addresses (Care Compare)

408 42ND Ave N
Suite 300
Nashville, TN 37209-3669
Phone (615) 356-4111

854 W James Campbell Blvd
Suite 101a
Columbia, TN 38401-4671
Phone (931) 388-3209

Medicare participation

Medicare fee-for-service enrollment: Enrolled in TN
Eligible to order & refer: Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
I20080505000436	TN	Practitioner - Nurse Practitioner	4486733235	Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD): Yes
Credentials: Nurse Practitioner

State licenses

License	State	Type	Specialty
13405	TN	MD	Physical Therapist

Practice roles

Organization	Specialty	Status	New patients
Nephrology Associates, PC	Acute Care	Current since Apr 14, 2008	Accepting new patients

Locations

854 W James M Campbell Blvd
Ste 101A
Columbia, TN 38401
Phone (931) 388-3209

28 White Bridge Pike
Ste 300
Nashville, TN 37205
Phone (615) 356-4111

120 Frank Martin Rd
Ste 202
Shelbyville, TN 37160
Phone (931) 393-4995

1801 N Washington St
Ste 300
Tullahoma, TN 37388
Phone (931) 393-4995

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Acute Care Nurse Practitioner	363LA2100X	13405	TN	Yes

Addresses

Primary practice location

1801 N Washington St
Ste. 300
Tullahoma, TN 37388-8245

Mailing address

1801 N Washington St
Ste. 300
Tullahoma, TN 37388-8245
Phone (931) 393-4995

Other identifiers

Identifier	Type	State	Issuer
3341754	Medicaid	TN

Other providers in Tullahoma, TN

Tamera Sue Bird
Joel Stanley Birdwell, M.D.
BKD Tullahoma, LLC
Mark Blair, M.D.
James Harrell Blanks, OD
Taylor Lanaux Blow, PAC
Bluebird Recovery LLC
Laurie Lynn Boland, M.A. CCC-SLP
Jessica Nicole Bonar, MSN, APRN, AGACNP-BC
Leanna Mashae Bonner

All providers in Tullahoma, TN · Acute Care Nurse Practitioner in Tennessee

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 29, 2013. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Order and Referring (CMS).
Medicare Care Compare provider data (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.