Active NPI
Karen Dyer Blackwell, P.A.
- Physician Assistant
- O Fallon, IL
National Provider Identifier
1487983664
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 085005182
- Practice address
- 310 N 7 Hills Rd
O Fallon, IL 62269-4111 - Phone
- (618) 624-6181
- Fax
- (618) 624-7172
- NPI assigned
- Dec 16, 2009
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 085005182 | IL | Primary |
Addresses
Primary practice location
310 N 7 Hills Rd
O Fallon, IL 62269-4111
Mailing address
4500 Memorial Drive
Memorial Hospital Medical Affairs
Belleville, IL 62226
Phone (618) 257-4644
Other names 1
- Karen Denise Dyer
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)
- Enrolled
- Credentials
- Physician Assistant
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1260921600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1456099200000",
"number": "1487983664",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4500 MEMORIAL DRIVE",
"address_2": "MEMORIAL HOSPITAL MEDICAL AFFAIRS",
"city": "BELLEVILLE",
"state": "IL",
"postal_code": "62226",
"telephone_number": "618-257-4644",
"fax_number": "618-257-6946"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "310 N 7 HILLS RD",
"city": "O FALLON",
"state": "IL",
"postal_code": "622694111",
"telephone_number": "618-624-6181",
"fax_number": "618-624-7172"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACKWELL",
"first_name": "KAREN",
"middle_name": "DYER",
"credential": "P.A.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-12-16",
"last_updated": "2016-02-22",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "IL",
"license": "085005182",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "KAREN",
"last_name": "DYER",
"middle_name": "DENISE",
"code": "1",
"type": "Former Name"
}
]
}Other providers in O Fallon, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.