Lisa Marie Blasko, FNP-C
Individual provider Active NPI Family Nurse Practitioner · Payson, AZ
NPI 1245646629 · NPPES record last updated Apr 29, 2026
Key facts
- NPI
- 1245646629
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- TAP5705 (AZ)
- Practice address
- 120 E Main St Ste B
Payson, AZ 85541-5618 - Phone
- (928) 472-2225
- Fax
- (928) 468-0002
- NPI assigned
- Jul 7, 2014
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 7
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2012
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Chelani Productions, LLC
Practice addresses (Care Compare)
120 E Main St
Suite B
Payson, AZ 85541-5618
Phone (928) 472-2225
Hospital & facility affiliations
- Banner Payson Medical Center
- Western Arizona Regional Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
- 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 |
|---|---|---|---|---|
| I20141021000523 | AZ | Practitioner - Nurse Practitioner | 9638390453 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN152442 | AZ | MD | Medical-Surgical Registered Nurse |
| TAP5705 | AZ | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Regenthetics, LLC | Current |
Accepting new patients | |
| North Country Healthcare, Inc. | Current | Accepting new patients | |
| Chelani Productions, LLC | Current |
Accepting new patients | |
| North Country Healthcare, Inc. | Current |
Accepting new patients | |
| North Country Healthcare, Inc. | Current | Accepting new patients | |
| North Country Healthcare Inc | Past | Accepting new patients | |
| North Country Healthcare, Inc. | Past | Accepting new patients |
Locations
2585 Miracle Mile
Ste 116
Bullhead City, AZ 86442
Phone (928) 704-1221
2187 N Vickey St
Ste 2
Flagstaff, AZ 86004
Phone (928) 527-1899
2500 N Rose St
Flagstaff, AZ 86004
Phone (928) 213-6121
2920 N 4th St
Flagstaff, AZ 86004
Phone (928) 213-6100
1120 W University Ave
Flagstaff, AZ 86001
Phone (928) 522-1300
2109 Navajo Blvd
Holbrook, AZ 86025
Phone (928) 213-6100
1510 N Stockton Hill Rd
Kingman, AZ 86401
Phone (928) 753-1177
2090 Smoketree Ave N
Lk Havasu Cty, AZ 86403
Phone (928) 854-1800
120 E Main St
Ste B
Payson, AZ 85541
Phone (928) 472-2225
126 E Main St
Ste B
Payson, AZ 85541
Phone (928) 472-3700
2650 E Show Low Lake Rd
Ste 1
Show Low, AZ 85901
Phone (928) 537-4300
488 S Mountain Ave
Springerville, AZ 85938
Phone (928) 333-0127
300 S 6th St
Williams, AZ 86046
Phone (928) 635-4441
620 Lee St
Winslow, AZ 86047
Phone (928) 288-8700
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | TAP5705 | AZ | Yes |
| Medical-Surgical Registered Nurse | 163WM0705X | RN152442 | AZ |
Addresses
Primary practice location
120 E Main St Ste B
Payson, AZ 85541-5618
Mailing address
113 E Brown Rd
Star Valley, AZ 85541-6561
Phone (928) 472-2225
Other names
- Lisa Marie Martin
Other providers in Payson, AZ
- Amy S Beier
- Charles M. Beier
- BHSM Rehabilitation, LLC
- BHSM Rehabilitation, LLC
- William Raymond Blackmore
- Tyri Norman Blondal
- Sheila Eva Bloomquist
- Bonanza Square Dentistry LLC
- Cynthia D Booth
- Steven Nicholas Booth
All providers in Payson, AZ · Family Nurse Practitioner in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 29, 2026. 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.