Active NPI
Courtney Blackmon, RD LD
- Registered Dietitian
- Columbia, SC
National Provider Identifier
1295375046
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- Practice address
- 209 Southwood Dr
Columbia, SC 29205-3221 - Phone
- (642) 764-4718
- NPI assigned
- Jan 9, 2020
- Last updated
- Jan 9, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | NU | Primary |
Addresses
Primary practice location
209 Southwood Dr
Columbia, SC 29205-3221
Mailing address
209 Southwood Dr
Columbia, SC 29205-3221
Phone (642) 764-4718
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Path of Life Nutrition | Dietitian, Registered | Current | Accepting new patients |
| Path of Life Nutrition | Dietitian, Registered | Current | Accepting new patients |
Locations
147 Vera Rd
Ste A
Lexington, SC 29072
Phone (803) 575-0468
905 Pope St
Newberry, SC 29108
Phone (803) 575-0468
Organizations & group practices 2
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1578528000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1578528000000",
"number": "1295375046",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "209 SOUTHWOOD DR",
"city": "COLUMBIA",
"state": "SC",
"postal_code": "292053221",
"telephone_number": "642-764-4718"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "209 SOUTHWOOD DR",
"city": "COLUMBIA",
"state": "SC",
"postal_code": "292053221",
"telephone_number": "642-764-4718"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACKMON",
"first_name": "COURTNEY",
"credential": "RD LD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-01-09",
"last_updated": "2020-01-09",
"certification_date": "2020-01-09",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Columbia, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.