Betty Ann Blasi, FNP
Individual provider Active NPI Family Nurse Practitioner · Jackson, MS
NPI 1285708958 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1285708958
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- R529435 (MS)
- Practice address
- 971 Lakeland Dr Ste 1250
Jackson, MS 39216-4609 - Phone
- (601) 366-1011
- Fax
- (601) 366-7311
- NPI assigned
- Nov 17, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MS, MA
- 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 |
|---|---|---|---|---|
| I20040915001085 | MS | Practitioner - Nurse Practitioner | 1153398367 | Reassigns benefits to 1 organization |
| I20180613001799 | MA | Practitioner - Nurse Practitioner | 1153398367 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R529435 | MS | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Community Care Health Network LLC | Current |
Accepting new patients |
Locations
9201 E Mountain View Rd
Ste 220
Scottsdale, AZ 85258
Phone (480) 862-1883
232 Market St
Jackson, MS 39232
Phone (588) 498-6767
Interoperability endpoints
- https://api.platform.athenahealth.com/16238/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | R529435 | MS | Yes |
Addresses
Primary practice location
971 Lakeland Dr Ste 1250
Jackson, MS 39216-4609
Mailing address
971 Lakeland Dr Ste 1250
Jackson, MS 39216-4609
Phone (601) 366-1011
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| R529435 | Other | MS | FNP LICENSE |
Other providers in Jackson, MS
- Bridgette Ann Bland
- Paula Leigh Bland
- Meghan Blankenship
- Adam K Blanks
- Kailin Danielle Blanton
- Blessings Beyond
- Blessings Beyond
- Wendy Nicole Blethen
- Phillip Blevins
- Tasha Blevins
All providers in Jackson, MS · Family Nurse Practitioner in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. 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).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.