Christina L Blake, NP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

21071 Issued in SC

Practice address

106 W Georgia Rd
Simpsonville, SC 29681-2302

Phone

(864) 662-6840

Fax

(864) 448-1720

NPI assigned

Apr 21, 2017

Last updated

Mar 19, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in SC, IA, WI, WA, MA, NY6 enrollments

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 6

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.

• Root Integrative Psychiatry

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Mauldin, SC
  • NPI 1932994696
  Medicare reassignment NPD Authorized official
• Broadlawns Medical Center

  • General Acute Care Hospital
  • Des Moines, IA
  • NPI 1467447508
  Medicare reassignment NPD
• Community Medical Associates, Inc.

  • Family Medicine Physician
  • Lawrence, MA
  • NPI 1144544040
  Medicare reassignment NPD
• Evizzit of Iowa Psychiatry PC

  dba Integrated Telehealth Partners

  • Psychiatry Physician
  • West Des Moines, IA
  • NPI 1740841188

  Psychiatric/Mental Health, SC, WA, WI

  Medicare reassignment NPD
• Integrated Telehealth Medicine PC

  • Psychiatry Physician
  • Oceanside, NY
  • NPI 1124870233

  Psychiatric/Mental Health

  Medicare reassignment NPD
• Prairie Ridge Integrated Behavioral Healthcare

  dba Prairie Ridge

  • Substance Abuse Rehabilitation Facility
  • Mason City, IA
  • NPI 1952443632
  Medicare reassignment NPD
• Watertown Physician Practices LLC

  • Family Medicine Physician
  • Watertown, WI
  • NPI 1770964363
  Medicare reassignment NPD
• Broadlawns Medical Center

  • Pharmacy
  • Des Moines, IA
  • NPI 1013197060
  NPD
• Prairie Ridge Integrated Behavioral Healthcare

  dba Prairie Ridge

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Mason City, IA
  • NPI 1801637061
  NPD
• Watertown Physician Practices LLC

  • Obstetrics & Gynecology Physician
  • Watertown, WI
  • NPI 1225412265

  Nurse Practitioner

  NPD
• Bend Health Psychiatric Services New England PA

  • Adolescent and Children Mental Health Clinic/Center
  • Madison, WI
  • NPI 1932864022
  NPD (past)
• Evizzit of Iowa Psychiatry PC

  • Adult Mental Health Clinic/Center
  • West Des Moines, IA
  • NPI 1679233183
  NPD (past)

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

{
    "created_epoch": "1492732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710806400000",
    "number": "1245765841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 W GEORGIA RD",
            "city": "SIMPSONVILLE",
            "state": "SC",
            "postal_code": "296812302",
            "telephone_number": "864-662-6840",
            "fax_number": "864-448-1720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 W GEORGIA RD",
            "city": "SIMPSONVILLE",
            "state": "SC",
            "postal_code": "296812302",
            "telephone_number": "864-662-6840",
            "fax_number": "864-448-1720"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "391 Serpentine Dr",
            "address_2": "SUITE 400",
            "address_purpose": "LOCATION",
            "city": "Spartanburg",
            "state": "SC",
            "postal_code": "293033096",
            "country_code": "US",
            "telephone_number": "864-560-7517",
            "fax_number": "864-560-7520",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "CHRISTINA",
        "middle_name": "L",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-04-21",
        "last_updated": "2024-03-19",
        "certification_date": "2024-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "SC",
            "license": "211071",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "SC",
            "license": "21071",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "SC",
            "license": "225614",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NP4579",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PIN",
            "identifier": "SCA8307652",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Connie J Blackstone, MD
• Marcus E Blackstone, MD
• Thomas Harold Blackwell, MD
• Thomas Matthew Blackwell, DMD
• Lindsay Blair
• Haley Elise Blake, FNP-BC
• Amanda Blanton
• Benjamin Allen Blanton, DPT
• Melody Garner Blighton, MSW, LISW-CP
• David Blondeau

• Psychiatric/Mental Health Nurse Practitioner in Simpsonville, SC
• Providers in Simpsonville, SC by specialty
• Psychiatric/Mental Health Nurse Practitioner in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.