Individual provider Active NPI

Heather Raelyn Blackford, RN

  • Registered Nurse
  • Hemet, CA
National Provider Identifier
1295299667
Registry record updated Jan 30, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
95037248 Issued in CA
Practice address
41847 Johnston Ave
Hemet, CA 92544-7535
Phone
(951) 445-1550
NPI assigned
Jan 30, 2019
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 30, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 95037248 CA Primary

Addresses

Primary practice location

41847 Johnston Ave
Hemet, CA 92544-7535

Mailing address

41847 Johnston Ave
Hemet, CA 92544-7535
Phone (951) 445-1550

Other names 1

  • Heather Raelyn Hansen Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Nurse

State licenses

LicenseStateTypeSpecialty
95037248CAMDRegistered Nurse

NPI Registry JSON

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

{
    "created_epoch": "1548806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548806400000",
    "number": "1295299667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "41847 JOHNSTON AVE",
            "city": "HEMET",
            "state": "CA",
            "postal_code": "925447535",
            "telephone_number": "951-445-1550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "41847 JOHNSTON AVE",
            "city": "HEMET",
            "state": "CA",
            "postal_code": "925447535",
            "telephone_number": "951-445-1550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKFORD",
        "first_name": "HEATHER",
        "middle_name": "RAELYN",
        "name_prefix": "Ms.",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-01-30",
        "last_updated": "2019-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "95037248",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "HEATHER",
            "last_name": "HANSEN",
            "middle_name": "RAELYN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Hemet, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.