Organization Active NPI

SB Dermatology PLLC

Doing business as Elite Dermatology Collective

  • Nurse Practitioner
  • Fayetteville, AR
National Provider Identifier
1629981790
Registry record updated Sep 28, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
SB DERMATOLOGY PLLC
Doing business as
Elite Dermatology Collective
Practice address
324 N College Ave RM 201
Fayetteville, AR 72701-4203
Phone
(479) 287-9978
NPI assigned
Sep 28, 2026
Last updated
Sep 28, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2026

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

Authorized official

Name
Dr. Joseph Blackmon, MD
Title
Member
Phone
(479) 287-9978

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X NU Primary

Addresses

Primary practice location

324 N College Ave RM 201
Fayetteville, AR 72701-4203

Mailing address

PO Box 8431
Fayetteville, AR 72703-0008
Phone (479) 287-9978

Other names 1

  • Elite Dermatology Collective Doing business as

NPI Registry JSON

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

{
    "created_epoch": "1790553600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1790553600000",
    "number": "1629981790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8431",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727030008",
            "telephone_number": "479-287-9978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "324 N COLLEGE AVE RM 201",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727014203",
            "telephone_number": "479-287-9978"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SB DERMATOLOGY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-09-28",
        "last_updated": "2026-09-28",
        "certification_date": "2026-09-27",
        "status": "A",
        "authorized_official_last_name": "BLACKMON",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "479-287-9978",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Elite Dermatology Collective",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fayetteville, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.

Verify at the official NPI Registry.