Lisa Diane Blacketter, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

209010216 Issued in IL

Practice address

815 N Virginia St
Port Lavaca, TX 77979-3025

Phone

(361) 552-6713

NPI assigned

Feb 7, 2013

Last updated

Jul 6, 2026By 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

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Citizens Medical Center County of VictoriaGroup PAC ID 3577785096, 102 clinicians

Memorial Medical CenterGroup PAC ID 3072403096, shared by 6 NPIs, 16 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Memorial Medical Center Hospital, Port Lavaca, TX, CCN 451356
• Citizens Medical Center Hospital, Victoria, TX, CCN 450023
• De Tar Hospital Navarro Hospital, Victoria, TX, CCN 450147

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

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.

• Citizen's Medical Center County of Victoria

  dba Citizens Medical Professional

  • Multi-Specialty Clinic/Center
  • Victoria, TX
  • NPI 1205242088
  Medicare reassignment Care Compare group NPD
• Citizens Medical Center County of Victoria

  • General Acute Care Hospital
  • Victoria, TX
  • NPI 1124052162
  NPD (past)
• Citizens Medical Center County of Victoria

  dba Citizens Medical Center Home Health Agency

  • Home Health Agency
  • Victoria, TX
  • NPI 1427106103
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Citizens Medical Center County of Victoria

  • General Acute Care Hospital
  • Victoria, TX
  • NPI 1124052162
  Care Compare affiliation
• Memorial Medical Center

  • Critical Access Hospital
  • Port Lavaca, TX
  • NPI 1689630865
  Care Compare affiliation
• Victoria of Texas LP

  dba Detar Healthcare System

  • General Acute Care Hospital
  • Victoria, TX
  • NPI 1851343909
  Care Compare affiliation

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

{
    "created_epoch": "1360195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783296000000",
    "number": "1851630040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "815 N VIRGINIA ST",
            "city": "PORT LAVACA",
            "state": "TX",
            "postal_code": "779793025",
            "telephone_number": "361-552-0222",
            "fax_number": "361-552-0220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "815 N VIRGINIA ST",
            "city": "PORT LAVACA",
            "state": "TX",
            "postal_code": "779793025",
            "telephone_number": "361-552-6713"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2701 Hospital Dr",
            "address_purpose": "LOCATION",
            "city": "Victoria",
            "state": "TX",
            "postal_code": "779015749",
            "country_code": "US",
            "telephone_number": "361-573-9181",
            "fax_number": "361-582-5743",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLACKETTER",
        "first_name": "LISA",
        "middle_name": "DIANE",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-02-07",
        "last_updated": "2026-07-06",
        "certification_date": "2026-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IL",
            "license": "209010216",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Rachel Renee Blackmon, PTA
• Olive Edwina Botor, PHARMD
• Kristi Boyd, FNP-C
• Stephen A Branch, RPH
• Victoria Leigh Brown, FNP-C

• Certified Registered Nurse Anesthetist in Port Lavaca, TX
• Providers in Port Lavaca, TX by specialty
• Certified Registered Nurse Anesthetist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.