Bettie Blackmon, FNP-C
Individual provider Active NPI Family Nurse Practitioner · Clinton, LA
NPI 1356344949 · NPPES record last updated Mar 7, 2023
Key facts
- NPI
- 1356344949
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- AP03903 (LA)
- Practice address
- 11990 Jackson St
Clinton, LA 70722-3210 - Phone
- (225) 683-5292
- Fax
- (225) 683-3411
- NPI assigned
- May 27, 2005
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 6
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2000
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Primary Care Providers for a Healthy Feliciana, Inc
Practice addresses (Care Compare)
11990 Jackson St
Clinton, LA 70722-3210
Phone (225) 683-5292
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in LA
- 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 |
|---|---|---|---|---|
| I20110105001032 | LA | Practitioner - Nurse Practitioner | 1254520307 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Primary Care Providers for a Healthy Feliciana, Inc. | Current |
Accepting new patients | |
| Primary Care Providers for a Healthy Feliciana, Inc | Current |
Accepting new patients | |
| Primary Care Providers for a Healthy Feliciana, Inc. | Current | Accepting new patients | |
| Primary Care Providers for a Healthy Feliciana Inc | Past | Accepting new patients | |
| Primary Care Providers for a Healthy Feliciana, Inc | Past | Accepting new patients | |
| Primary Care Providers for a Healthy Feliciana, Inc | Past | Accepting new patients |
Locations
455 E Airport Ave
Baton Rouge, LA 70806
Phone (225) 570-2300
11990 Jackson St
Clinton, LA 70722
Phone (225) 570-6111
10410 Plank Rd
Clinton, LA 70722
Phone (225) 683-8877
28315 S Frost Rd
Livingston, LA 70754
Phone (225) 283-1356
54016 Highway 1062
Loranger, LA 70446
Phone (985) 606-9000
3553 Rosedale Rd
Port Allen, LA 70767
Phone (225) 234-0227
Interoperability endpoints
- bettie.blackmon.p1@direct.rkmprimarycare.nextgenshare.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | AP03903 | LA | Yes |
Addresses
Primary practice location
11990 Jackson St
Clinton, LA 70722-3210
Mailing address
PO Box 395
Clinton, LA 70722-0395
Phone (225) 683-5292
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114367 | Medicaid | LA |
Other providers in Clinton, LA
- Kelli R Barbay
- Christina Hamilton Barrett
- Michael David Barry
- Urhonda Beckwith
- Beante Y Beverly-Holmes
- Latoya Monique Branch
- Karla V Bringedahl
- Sheri Broussard
- Ariel Marie Brown
- John Patrick Brumfield
All providers in Clinton, LA · Family Nurse Practitioner in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 7, 2023. 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).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.