Amber Lauren Blacknall, DNP, PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

70510 Issued in NM

Practice address

6612 Gulton CT NE
Albuquerque, NM 87109-4407

Phone

(505) 316-5966

NPI assigned

Oct 31, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Sep 18, 2024 through Sep 18, 2026

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mustang Management Group TR

  dba On The Mend MH

  • Psychiatric/Mental Health Nurse Practitioner
  • Albuquerque, NM
  • NPI 1669233789
  NPD Authorized official

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

{
    "created_epoch": "1667174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707436800000",
    "number": "1447967435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 MARQUETTE AVE NW STE 1219",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871025340",
            "telephone_number": "505-316-5966",
            "fax_number": "505-422-4073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6612 GULTON CT NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871094407",
            "telephone_number": "505-316-5966"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "500 Marquette Ave NW Ste 1219",
            "address_purpose": "LOCATION",
            "city": "Albuquerque",
            "state": "NM",
            "postal_code": "871025340",
            "country_code": "US",
            "telephone_number": "505-316-5966",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLACKNALL",
        "first_name": "AMBER",
        "middle_name": "LAUREN",
        "credential": "DNP, PMHNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-10-31",
        "last_updated": "2024-02-09",
        "certification_date": "2024-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NM",
            "license": "70510",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mackenzie Blackburn
• Shawne Ann Blackburn, LPCC
• Charlene Blackledge, COTA
• Lisa Christine Blacklock, M.D.
• Mary Blacklock
• Ethan Blackney-Lopez, AG-ACNP
• Cheri A Blacksten, MD
• Jacquelyn A Blackstone, DO
• Robert Blackstone, PA-C
• Blackthorne Inc (Blackthorne Botanicals and Bodywork)

• Psychiatric/Mental Health Nurse Practitioner in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Psychiatric/Mental Health Nurse Practitioner in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.