Temekia Shauntrice Blakely

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

AG0223047 Issued in AL

Practice address

11653 County Road 7
Troy, AL 36081-7157

Phone

(334) 300-2819

NPI assigned

Oct 9, 2023

Sex

Female

Sole proprietor

No

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.

• Signify Health, LLC

  • General Practice Physician
  • Dallas, TX
  • NPI 1689158487

  AL

  Medicare reassignment

Specialty

Nurse Practitioner

Education

University of South Alabama College of Medicine, 2021

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare fee-for-service enrollment

Enrolled in AL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

Specialties & licenses 3

Addresses

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

{
    "created_epoch": "1696809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696809600000",
    "number": "1487435202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11653 COUNTY ROAD 7",
            "city": "TROY",
            "state": "AL",
            "postal_code": "360817157",
            "telephone_number": "334-300-2819"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11653 COUNTY ROAD 7",
            "city": "TROY",
            "state": "AL",
            "postal_code": "360817157",
            "telephone_number": "334-300-2819"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKELY",
        "first_name": "TEMEKIA",
        "middle_name": "SHAUNTRICE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-10-09",
        "last_updated": "2023-10-09",
        "certification_date": "2023-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "AL",
            "license": "1-1414215",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "AL",
            "license": "AG0223047",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "AL",
            "license": "AG0223047",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sydney Erin Bishop
• Jaycie Black
• Kenneth Allen Blackmon Jr., D.M.D.
• Maggie Chandler Blagburn
• Danielle Blair
• Patricia A Block, M.D.
• John M Blough, D.O.
• Keara Emerald Cheyenne Bogart
• Jennifer Lincy Boutwell
• Laura Beth Jones Boutwell, PHARMD

• All providers in Troy, AL
• Adult Health Nurse Practitioner in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.