Active NPI
Jacqueline Blakemore
- Social Worker
- Sierra Vista, AZ
National Provider Identifier
1376932046
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 0003205
- Practice address
- 75 N Garden Ave
Sierra Vista, AZ 85635-3805 - Phone
- (520) 732-0871
- NPI assigned
- Jan 17, 2015
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 0003205 | AZ | Primary |
Addresses
Primary practice location
75 N Garden Ave
Sierra Vista, AZ 85635-3805
Mailing address
75 N Garden Ave
Sierra Vista, AZ 85635-3805
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0003205 | Other | AZ | PEER SUPPORT SPECIALIST |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0003205 | AZ | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1421452800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1425513600000",
"number": "1376932046",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "75 N GARDEN AVE",
"city": "SIERRA VISTA",
"state": "AZ",
"postal_code": "856353805"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "75 N GARDEN AVE",
"city": "SIERRA VISTA",
"state": "AZ",
"postal_code": "856353805",
"telephone_number": "520-732-0871"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLAKEMORE",
"first_name": "JACQUELINE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-01-17",
"last_updated": "2015-03-05",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "AZ",
"license": "0003205",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PEER SUPPORT SPECIALIST",
"identifier": "0003205",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sierra Vista, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.