Anisa Blackwell

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Practice address

3000 Latrobe Dr Ste B
Charlotte, NC 28211-5227

Phone

(704) 612-6537

Fax

(888) 261-6694

NPI assigned

Feb 3, 2021

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1612310400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612310400000",
    "number": "1831780667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7503 MISTY VIEW CT",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282152872",
            "telephone_number": "704-501-7527"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 LATROBE DR STE B",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282115227",
            "telephone_number": "704-612-6537",
            "fax_number": "888-261-6694"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKWELL",
        "first_name": "ANISA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-02-03",
        "last_updated": "2021-02-03",
        "certification_date": "2021-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Reginald Blackmon Sr.
• Zondra Blackmon, LMBT
• Karen H Blackwelder, PA-C
• Kennedy Elizabeth Blackwelder
• Wesley E. Blackwelder, CRNA
• Ashley Lynn Blackwell, CRNA
• Daniel B Blackwell
• Derrick Lewis Blackwell, DO
• James Blackwell, NP
• James Matthew Blackwell, MD

• Behavior Technician in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Behavior Technician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2021; 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.