Alice T Blackmon, PNP-C

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

AP108315 Issued in TX

Practice address

7323 Marbach Rd Ste 104
San Antonio, TX 78227-1905

Phone

(210) 645-4305

Fax

(210) 673-1850

NPI assigned

Nov 8, 2005

Last updated

Mar 9, 2026By 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 1

Addresses

Other identifiers 5

Other names 1

• Alicia T Blackmon Professional name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in TX

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner, Physician Assistant

Practice roles

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.

• Kellum Medical Group, PA

  • Family Medicine Physician
  • San Antonio, TX
  • NPI 1508813494
  Medicare reassignment
• Kellum Physician Partners, PA

  • Obstetrics & Gynecology Physician
  • San Antonio, TX
  • NPI 1073880092
  NPD (past)

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

{
    "created_epoch": "1131408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773014400000",
    "number": "1265413264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7323 MARBACH RD STE 104",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782271905",
            "telephone_number": "210-674-0257",
            "fax_number": "210-369-9064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7323 MARBACH RD STE 104",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782271905",
            "telephone_number": "210-645-4305",
            "fax_number": "210-673-1850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKMON",
        "first_name": "ALICE",
        "middle_name": "T",
        "credential": "PNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-08",
        "last_updated": "2026-03-09",
        "certification_date": "2026-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "TX",
            "license": "AP108315",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GRP TAXONOMY",
            "identifier": "193200000X",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ALICE BLACKMON, PNP-C   NPI#",
            "identifier": "1265413264",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "AP108315",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP PRACTICE/BILLING NPI#",
            "identifier": "1508813494",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL TAXONOMY",
            "identifier": "363LP0200X",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "marbach_ma@kellummedical.com",
            "affiliation": "N",
            "endpointDescription": "Email",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Email",
            "address_1": "7323 Marbach Rd Ste 104",
            "city": "San Antonio",
            "state": "TX",
            "country_code": "US",
            "postal_code": "782271905",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "ALICIA",
            "last_name": "BLACKMON",
            "middle_name": "T",
            "credential": "PNP-C",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Daniel E Blackburn
• Steven Joseph Blackburn, LVN
• David Dillard Blackerby II, CNC
• Blackland Prairie Medical PLLC
• Chris Blacklock, ATP
• Ashley Blackmon, DPM
• Beatrice L Blackmon, LCSW
• Tiffany Faye Blackmon, RN
• Heather Blackmond, D.M.D.
• Ashley Blackmore

• Pediatric Nurse Practitioner in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Pediatric Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2026; 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.