Nanci Jacqulyn Sullivan-Blackert, RN, MSN, CDE, NP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

5005832 Issued in NC

Practice address

3604 Bush St
Raleigh, NC 27609-7511

Phone

(919) 876-7807

Fax

(919) 459-8402

NPI assigned

Jul 31, 2012

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

Other identifiers 4

Other names 1

• Nanci Sullivan Blackert Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing, Nurse Practitioner, Registered Nurse

State licenses

Practice roles

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.

• Pinehurst Medical Clinic, Inc.

  dba PMC Reference Lab

  • Clinical Medical Laboratory
  • Southern Pines, NC
  • NPI 1962509372
  NPD (past)

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

{
    "created_epoch": "1343692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1470873600000",
    "number": "1568718336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3604 BUSH ST",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276097511",
            "telephone_number": "919-876-7807",
            "fax_number": "919-459-8402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3604 BUSH ST",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276097511",
            "telephone_number": "919-876-7807",
            "fax_number": "919-459-8402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN-BLACKERT",
        "first_name": "NANCI",
        "middle_name": "JACQULYN",
        "credential": "RN, MSN, CDE, NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-31",
        "last_updated": "2016-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "F0512372",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "5005832",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST CAROLINA CARE, INC",
            "identifier": "FH4001480",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST MEDICARE DIRECT",
            "identifier": "FH4001480",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1568718336",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HNFS/TRICARE",
            "identifier": "1568718336",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NANCI",
            "last_name": "BLACKERT",
            "middle_name": "SULLIVAN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Deonna Suiter, PTA
• Rebecca Lynn Sukhu, MS, CF-SLP
• Whitney Luffman Sukonick, MA, LPA, BCBA
• Rohit Sukumar
• Kelly Sulek, DPT
• Bianca Sullivan, LMBT
• Candice Marie Sullivan, PHARM D.
• Jamie Sullivan, ARNP, FNP
• Jennifer Sullivan
• John W Sullivan, LPC

• Family Nurse Practitioner in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Family Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 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.

Verify at the official NPI Registry.