Kimberly Nicole Blackwell, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0010-15641 Issued in NC

Practice address

613 Shipyard Blvd Ste 106
Wilmington, NC 28412-6491

Phone

(910) 202-3068

NPI assigned

Aug 30, 2023

Last updated

Oct 21, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Enrolled in NC

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

Specialty

Physician Assistant

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Coastal Horizons Center, Inc.Group PAC ID 9739267964, 50 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Novant Health New Hanover Regional Medical Center Hospital, Wilmington, NC, CCN 340141

Medicare enrollment (NPD)

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Coastal Horizons Center, Inc.

  • Community/Behavioral Health Agency
  • Wilmington, NC
  • NPI 1922022607
  Medicare reassignment Care Compare group NPD
• Coastal Horizons Center Inc

  • Community/Behavioral Health Agency
  • Rocky Point, NC
  • NPI 1063082592
  NPD
• Coastal Horizons Center, Inc.

  • Community/Behavioral Health Agency
  • Wilmington, NC
  • NPI 1790985448
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Novant Health New Hanover Regional Medical Center LLC

  dba Novant Health New Hanover Regional Medical Center

  • General Acute Care Hospital
  • Wilmington, NC
  • NPI 1376139139
  Care Compare affiliation

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

{
    "created_epoch": "1693353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761004800000",
    "number": "1487439089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 SHIPYARD BLVD STE 106",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284126431",
            "telephone_number": "910-202-3860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "613 SHIPYARD BLVD STE 106",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284126491",
            "telephone_number": "910-202-3068"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1414 Medical Center Dr",
            "address_purpose": "LOCATION",
            "city": "Wilmington",
            "state": "NC",
            "postal_code": "284017505",
            "country_code": "US",
            "telephone_number": "910-790-9949",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "615 Shipyard Blvd",
            "address_purpose": "LOCATION",
            "city": "Wilmington",
            "state": "NC",
            "postal_code": "284126431",
            "country_code": "US",
            "telephone_number": "910-343-0145",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7910 US Hwy 117 S # A",
            "address_purpose": "LOCATION",
            "city": "Rocky Point",
            "state": "NC",
            "postal_code": "284579431",
            "country_code": "US",
            "telephone_number": "910-259-0668",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7910 US Hwy 117 S",
            "address_purpose": "LOCATION",
            "city": "Rocky Point",
            "state": "NC",
            "postal_code": "284579431",
            "country_code": "US",
            "telephone_number": "910-259-0668",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "120 Coastal Horizons Dr",
            "address_purpose": "LOCATION",
            "city": "Shallotte",
            "state": "NC",
            "postal_code": "284706094",
            "country_code": "US",
            "telephone_number": "910-754-4515",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLACKWELL",
        "first_name": "KIMBERLY",
        "middle_name": "NICOLE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-08-30",
        "last_updated": "2025-10-21",
        "certification_date": "2025-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-15641",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melissa Whitesell Black, CNM
• Charles T Blackburn, CRNA
• Linda Blackburn, RPH
• Siara Southerland Blackburn
• Thomas L Blackstone, MD
• Shelby Layne Blackwell, FNP-C
• Caitlin Morgan Blades, MD
• Catherine Blair, NP-C
• Dwight Blair, MD
• Melissa M Blair, PHARMD

• Physician Assistant in Wilmington, NC
• Providers in Wilmington, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2025; 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.