Destinee D Blackwell-Clary, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

LPN.177387.MEDS-IV Issued in OH

Practice address

8978 United LN Ste 102
Athens, OH 45701-3668

Phone

(740) 274-4246

NPI assigned

Jul 20, 2021

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

Other names 1

• Destinee D Blackwell Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

• Pinnacle Treatment Centers Oh-Xvi, LLC

  dba Athens Treatment Services

  • Methadone Clinic
  • Athens, OH
  • NPI 1255942223
  NPD

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

{
    "created_epoch": "1626739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668816000000",
    "number": "1558934364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 188",
            "city": "CHILLICOTHE",
            "state": "OH",
            "postal_code": "456010188",
            "telephone_number": "740-773-4366",
            "fax_number": "740-773-4750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8978 UNITED LN STE 102",
            "city": "ATHENS",
            "state": "OH",
            "postal_code": "457013668",
            "telephone_number": "740-274-4246"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKWELL-CLARY",
        "first_name": "DESTINEE",
        "middle_name": "D",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-20",
        "last_updated": "2022-11-19",
        "certification_date": "2022-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "OH",
            "license": "LPN.177387.MEDS-IV",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DESTINEE",
            "last_name": "BLACKWELL",
            "middle_name": "D",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Courtney B Bishop, LSW
• Jessica Bishop, LPN
• Samantha Bistline
• Betty Blackburn
• Shawna May Blackburn
• Aja L Blackwell-Collins, CDCA
• Arica Blackwell-Smith, CDCA
• Kiersten Blackwell
• Shari Blackwell, LPN
• Kaitlynn E. Blair, QMHS

• Licensed Practical Nurse in Athens, OH
• Providers in Athens, OH by specialty
• Licensed Practical Nurse in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.