Kelly Jean Bleakney

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

APN.0996244-NP Issued in CO

Practice address

106 Blanca Ave
Alamosa, CO 81101-2340

Phone

(719) 589-2511

NPI assigned

Mar 9, 2020

Last updated

Feb 11, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Kelly Jean Martinez Former name

Medicare fee-for-service enrollment

Enrolled in CO

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, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lutheran Hospital Association of the San Luis ValleyGroup PAC ID 4789589094, 146 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• San Luis Valley Regional Medical Center Hospital, Alamosa, CO, CCN 060008

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Lutheran Hospital Association of the San Luis Valley

  dba San Luis Valley Health Regional Medical Center

  • General Acute Care Hospital
  • Alamosa, CO
  • NPI 1235181744
  Medicare reassignment Care Compare group NPD
• Lutheran Hospital Association of the San Luis Valley

  dba San Luis Valley Health Stuart Avenue Clinic

  • Internal Medicine Physician
  • Alamosa, CO
  • NPI 1972556744
  NPD
• Lutheran Hospital Association of the San Luis Valley

  dba SLV Health La Jara Clinic

  • Rural Health Clinic/Center
  • La Jara, CO
  • NPI 1942511019
  NPD (past)

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

• Lutheran Hospital Association of the San Luis Valley

  dba San Luis Valley Health Regional Medical Center

  • General Acute Care Hospital
  • Alamosa, CO
  • NPI 1235181744
  Care Compare affiliation

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

{
    "created_epoch": "1583712000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613001600000",
    "number": "1235764374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4810 SIERRA VISTA RD",
            "city": "ALAMOSA",
            "state": "CO",
            "postal_code": "811018900",
            "telephone_number": "719-850-0666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 BLANCA AVE",
            "city": "ALAMOSA",
            "state": "CO",
            "postal_code": "811012340",
            "telephone_number": "719-589-2511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLEAKNEY",
        "first_name": "KELLY",
        "middle_name": "JEAN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-03-09",
        "last_updated": "2021-02-11",
        "certification_date": "2021-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CO",
            "license": "APN.0996244-NP",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CO",
            "license": "0161722",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "MARTINEZ",
            "middle_name": "JEAN",
            "credential": "FNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Elinor L Bethke, R.M.N.S C.N.S.
• Cody Biby
• Laurie Billman, LPC
• Debora Ann Black, RN
• Amy Nicole Blakeslee, PA-C
• Blue Peaks Developmental Services Inc
• Blue Peaks Developmental Services Inc
• Blue Peaks Developmental Services Inc
• Blue Peaks Developmental Services Inc
• Blue Peaks Developmental Services Inc

• Family Nurse Practitioner in Alamosa, CO
• Providers in Alamosa, CO by specialty
• Family Nurse Practitioner in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2021; 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.