Shannon Blankenbeckler, AGNP-C, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

5007563 Issued in NC

Practice address

2909 Market St
Wilmington, NC 28403-1221

Phone

(910) 795-2118

Fax

(910) 795-2318

NPI assigned

Feb 17, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

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

Nurse Practitioner

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Medpsych Integrated PLLCGroup PAC ID 2062759202, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: shannon.blankenbeckler.1@28779.direct.athenahealth.com
• Direct secure messaging: shannon.blankenbeckler@3943.securemail.prognocis.com
• Direct secure messaging: sohomd.shannonblankenbeckler@157389.advancedmd-direct.com

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.

• Medpsych Integrated PLLC

  • Psychiatry Physician
  • Raleigh, NC
  • NPI 1154898013
  Medicare reassignment Care Compare group NPD
• Columbus Regional Healthcare System

  dba South Columbus Medical Clinic

  • General Acute Care Hospital
  • Whiteville, NC
  • NPI 1376537555
  Medicare reassignment NPD
• Columbus Regional Healthcare System

  dba Donayre Cancer Care Center Pharmacy

  • Specialty Pharmacy
  • Whiteville, NC
  • NPI 1275079451
  NPD

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

{
    "created_epoch": "1424131200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658620800000",
    "number": "1508257221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 LAVEEN WAY",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284122697",
            "telephone_number": "910-470-8496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2909 MARKET ST",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284031221",
            "telephone_number": "910-795-2118",
            "fax_number": "910-795-2318"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLANKENBECKLER",
        "first_name": "SHANNON",
        "credential": "AGNP-C, PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-02-17",
        "last_updated": "2022-07-24",
        "certification_date": "2022-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NC",
            "license": "BLAN-GIKLC9",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NC",
            "license": "5007563",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Zachary Ian Blake
• Chelsea Kaylan Blanchard, CRNA
• Donald Sheffield Bland, D.D.S.
• Tiana Blanding, LCSWA
• Ana Rita Blaney, LCSW
• Kenneth Roland Blanton, PA
• Pia Blanton, P.T
• Anna Lee Blazer
• Ryan Charles Blejewski, BCBA
• Hope Gerock Blevens

• Psychiatric/Mental Health Nurse Practitioner in Wilmington, NC
• Providers in Wilmington, NC by specialty
• Psychiatric/Mental Health Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2022; 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.