Samantha D'Ann Blackburn, PMHNP-BC; FNP-C
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Meridian, ID
NPI 1811534613 · NPPES record last updated May 7, 2026
Key facts
- NPI
- 1811534613
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 65041 (ID)
- Practice address
- 3709 N Locust Grove Rd Ste 150
Meridian, ID 83646-5924 - Phone
- (208) 208-5430
- Fax
- (208) 208-5431
- NPI assigned
- Nov 29, 2019
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 6
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
- Opted out of Medicare
- Yes, effective May 20, 2026 through May 20, 2028
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 65041 | ID | MD | Acute Care Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Meridian Advanced Psychiatry , LLC | Current |
Accepting new patients | |
| Ancora Hospice & Palliative Services, LLC | Current |
Accepting new patients | |
| Ancora Hospice & Palliative Services, LLC | Family Medicine | Current |
Accepting new patients |
| Serenity Springs Wellness, PLLC | Psychiatric/Mental Health | Current | Accepting new patients |
| Wellspring Behavioral Health, Inc | Psychiatric/Mental Health | Past | Accepting new patients |
| Heart 'N Home Hospice and Palliative Care, LLC | Family Medicine | Past | Accepting new patients |
Locations
808 N Whitley Dr
Fruitland, ID 83619
Phone (208) 452-2672
1672 S Woodsage Ave
Ste 120
Meridian, ID 83642
Phone (208) 515-2273
3709 N Locust Grove Rd
#150
Meridian, ID 83646
Phone (208) 208-5430
660 E Franklin Rd
Ste 140
Meridian, ID 83642
Phone (208) 992-2672
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acute Care Nurse Practitioner | 363LA2100X | 65041 | ID | |
| Family Nurse Practitioner | 363LF0000X | 65041 | ID | |
| Registered Nurse | 163W00000X | 47259 | ID | |
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 65041 | ID | Yes |
Addresses
Primary practice location
3709 N Locust Grove Rd Ste 150
Meridian, ID 83646-5924
Mailing address
3709 N Locust Grove Rd Ste 150
Meridian, ID 83646-5924
Phone (208) 208-5430
Other names
- Ms. Samantha D'Ann Fundingsland
Other providers in Meridian, ID
- Ashley Elizabeth Birkland
- Octavian Bistriceanu
- Erica Ann Black
- Nicole Black
- Tarah Black
- Amy Blackledge
- Blackmer Podiatry
- Blackrock Orthopedic Specialists LLC
- Lacee Danielle Blackstone
- Chad Blair
All providers in Meridian, ID · Psychiatric/Mental Health Nurse Practitioner in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 7, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.