Kissi Rosabel Blackwell, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

N1556 Issued in TX

Practice address

4610 Kell Blvd
Wichita Falls, TX 76310-1466

Phone

(940) 441-2273

Fax

(844) 299-0602

NPI assigned

Jul 28, 2008

Last updated

Jan 5, 2021By 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 2

Addresses

Other names 1

• Dr. Kissi Rosabel Torres Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jul 1, 2017 through Jul 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://epicproxy.et1096.epichosted.com/FHIRProxy/api/FHIR/DSTU2/
• FHIR API: https://epicproxy.et1096.epichosted.com/FHIRProxy/api/fhir/r4/
• Direct secure messaging: kblackwell13418@unitedregional.medalliesdirect.net

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.

• United Regional Health Care System Inc

  dba United Regional Heath Care System

  • General Acute Care Hospital
  • Wichita Falls, TX
  • NPI 1023013448
  NPD

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

{
    "created_epoch": "1217203200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609804800000",
    "number": "1629233770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4610 KELL BLVD",
            "city": "WICHITA FALLS",
            "state": "TX",
            "postal_code": "763101466",
            "telephone_number": "940-441-2273",
            "fax_number": "844-299-0602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4610 KELL BLVD",
            "city": "WICHITA FALLS",
            "state": "TX",
            "postal_code": "763101466",
            "telephone_number": "940-441-2273",
            "fax_number": "844-299-0602"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4327 Barnett Rd",
            "address_purpose": "LOCATION",
            "city": "Wichita Falls",
            "state": "TX",
            "postal_code": "763102303",
            "country_code": "US",
            "telephone_number": "940-764-5200",
            "fax_number": "940-764-5201",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4327 Barnett Rd",
            "address_purpose": "LOCATION",
            "city": "Wichita Falls",
            "state": "TX",
            "postal_code": "76310",
            "country_code": "US",
            "telephone_number": "940-764-5200",
            "fax_number": "940-764-5201",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4327 Barnett Rd",
            "address_purpose": "LOCATION",
            "city": "Wichita Falls",
            "state": "TX",
            "postal_code": "76310",
            "country_code": "US",
            "telephone_number": "940-764-5200",
            "fax_number": "940-764-5201",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLACKWELL",
        "first_name": "KISSI",
        "middle_name": "ROSABEL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-07-28",
        "last_updated": "2021-01-05",
        "certification_date": "2021-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "TX",
            "license": "BP10024819",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "N1556",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KISSI",
            "last_name": "TORRES",
            "middle_name": "ROSABEL",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Ashley Dawn Bishop, PT
• Tammie Lynn Bishop, ACNP-BC
• Paul Robert Black, RPH
• Nickolas Blackburn, RBT
• Nanette Blacklock, LPT
• Russell Dell Blackwell, D.C.
• Blackwood Care Associate
• Denise Delynn Blair, RN CNS
• Ronald D. Blankenship, DDS
• Emily Blanton, OT

• Family Medicine Physician in Wichita Falls, TX
• Providers in Wichita Falls, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2021; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.