Sally Blackburn, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

0024164957 Issued in VA

Practice address

2195 Euclid Ave
Suite 6
Bristol, VA 24201-3655

Phone

(276) 669-5179

Fax

(276) 466-8870

NPI assigned

Feb 1, 2006

Last updated

Oct 5, 2016By 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 1

Addresses

Other identifiers 1

Other names 1

• Sally Pennings Former name

Medicare fee-for-service enrollment

Enrolled in VA, TN2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Blue Ridge Medical Management Corporation

  dba First Assist Urgent Care

  • Urgent Care Clinic/Center
  • Elizabethton, TN
  • NPI 1144380833
  Medicare reassignment NPD
• Southwest Virginia Community Health Systems Incorporated

  • Federally Qualified Health Center (FQHC)
  • Saltville, VA
  • NPI 1811967169
  NPD
• Blue Ridge Medical Management Corporation

  dba Ballad Health Medical Associates

  • Cardiovascular Disease Physician
  • Johnson City, TN
  • NPI 1740227131

  Family

  NPD

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

{
    "created_epoch": "1138752000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1475625600000",
    "number": "1700857216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 729",
            "city": "SALTVILLE",
            "state": "VA",
            "postal_code": "243700729",
            "telephone_number": "276-496-4492",
            "fax_number": "276-496-4839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2195 EUCLID AVE",
            "address_2": "SUITE 6",
            "city": "BRISTOL",
            "state": "VA",
            "postal_code": "242013655",
            "telephone_number": "276-669-5179",
            "fax_number": "276-466-8870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKBURN",
        "first_name": "SALLY",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-01",
        "last_updated": "2016-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024164957",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q006676",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SALLY",
            "last_name": "PENNINGS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Latoshia Renee Belcher, LPC
• Jessica N Bembry, FNP
• Betsy a Rose
• Victoria Cross Bettis, DDS
• Randy A Birt, OD
• Shirley R Blake, M.S.
• BLC Bristol-GC, LLC (Grand Court Bristol)
• Christy McGhee Blevins, NP
• Courtney Lange Blevins
• Alton Joseph Blow, MD

• Family Nurse Practitioner in Bristol, VA
• Providers in Bristol, VA by specialty
• Family Nurse Practitioner in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2016; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.