Anita Jane Blackwell, RNCPNP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

061036 Issued in MO

Practice address

4055 Lindell Blvd
Saint Louis, MO 63108-3201

Phone

(314) 535-7701

Fax

(314) 535-0207

NPI assigned

Apr 7, 2007

Last updated

Sep 22, 2022By 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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

• Abc Pediatric Clinic, P.a.

  • Pediatrics Physician
  • Houston, TX
  • NPI 1417125642
  NPD
• Topcare Medical Group Inc

  dba MD Kids Pediatrics

  • Pediatrics Physician
  • Dallas, TX
  • NPI 1285016758
  NPD
• Topcare Medical Group Inc

  dba Clinicas Mi Doctor

  • Specialist
  • Dallas, TX
  • NPI 1730337163
  NPD

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

{
    "created_epoch": "1175904000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663804800000",
    "number": "1790808681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12377 MERIT DR STE 300",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752513126",
            "telephone_number": "972-957-3000",
            "fax_number": "972-957-3005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4055 LINDELL BLVD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631083201",
            "telephone_number": "314-535-7701",
            "fax_number": "314-535-0207"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKWELL",
        "first_name": "ANITA",
        "middle_name": "JANE",
        "name_prefix": "Miss",
        "credential": "RNCPNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-07",
        "last_updated": "2022-09-22",
        "certification_date": "2022-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "TX",
            "license": "AP133887",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MO",
            "license": "061036",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Taiyonna Marshea Lynnese Blackmon, LPN
• Blackmun Footcare LLC
• Carol D Blacksher, APRN BC
• Blackwell & Roscoe Autism Spectrum Intervention Partners, Inc.
• Allison Blackwell
• Danielle Carmen Blackwell, ACNP
• Deborah A Blackwell, MSN, RN, FNP-C
• Gillian Blackwell, ANP
• Mary Wallace Blackwell, EDS, MED, BSED
• Rebecca Blackwell, BCBA

• Pediatric Nurse Practitioner in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Pediatric Nurse Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2022; 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.