Jo Susan Offutt-Blackaby, MSN, PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

19574 Issued in TN

Practice address

2006 Maggie CT
Greenbrier, TN 37073-0500

Phone

(615) 620-0998

NPI assigned

Jan 13, 2015

Last updated

Jan 4, 2024By 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 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing

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.

• South Carolina Dept of Mental Health Accounting Office

  dba Beckman Mental Health

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Greenwood, SC
  • NPI 1124135009
  NPD (past)

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

{
    "created_epoch": "1421107200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704326400000",
    "number": "1689063760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2006 MAGGIE CT",
            "city": "GREENBRIER",
            "state": "TN",
            "postal_code": "370730500",
            "telephone_number": "615-970-9467",
            "fax_number": "615-246-9030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2006 MAGGIE CT",
            "city": "GREENBRIER",
            "state": "TN",
            "postal_code": "370730500",
            "telephone_number": "615-620-0998"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OFFUTT-BLACKABY",
        "first_name": "JO",
        "middle_name": "SUSAN",
        "credential": "MSN, PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-01-13",
        "last_updated": "2024-01-04",
        "certification_date": "2024-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "SC",
            "license": "25460",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TN",
            "license": "19574",
            "primary": true
        },
        {
            "code": "364SP0808X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Psychiatric/Mental Health",
            "state": "TN",
            "license": "19574",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "3335",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "421504",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Juliet Lavie, APRN, PMHNP-BC
• Riley Lawyer, DPT
• William Michael Lewis, MD
• Amy Niccole Madden-Ray, LCSW
• Charles Andrew Mullins, DO
• Cinthya C Ortiz Morales, FNP-C
• Lauren Pannell, DPT
• Patricia M Powers, FNP
• Kristina Opal Protzman, P.T.A
• Providence Medical Clinic LLC

• Psychiatric/Mental Health Nurse Practitioner in Greenbrier, TN
• Providers in Greenbrier, TN by specialty
• Psychiatric/Mental Health Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2024; 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.