Patricia Louise Blackledge, ARNP MS
Individual provider Active NPI Nurse Practitioner · Centerville, IA
NPI 1871586271 · NPPES record last updated Dec 29, 2023
Key facts
- NPI
- 1871586271
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- A097156 (IA)
- Practice address
- 1015 N 18TH St
Centerville, IA 52544-1170 - Phone
- (641) 684-6896
- Fax
- (641) 226-5759
- NPI assigned
- Aug 31, 2005
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 13
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040621000377 | IA | Practitioner - Nurse Practitioner | 6901881440 | Reassigns benefits to 4 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Master of Science, Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 097156 | IA | MD | Registered Nurse |
| A097156 | IA | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Iowa Clinic, PC | Current |
Accepting new patients | |
| Davis County Hospital | Current |
Accepting new patients | |
| Vpa PC | Current |
Accepting new patients | |
| Grinnell Regional Medical Center | Nurse Practitioner | Current |
Accepting new patients |
| Vpa PC | Current |
Accepting new patients | |
| Davis County Hospital | Current |
Accepting new patients | |
| The Iowa Clinic PC | Current |
Accepting new patients | |
| Ottumwa Regional Health Center Inc | Past | Accepting new patients | |
| RCHP Ottumwa LLC | Past | Accepting new patients | |
| Wapello Emergency Group PC | Nurse Practitioner | Past | Accepting new patients |
| River Hills Community Health Center Inc | Past |
Accepting new patients | |
| Dallas County Hospital | Past | Accepting new patients | |
| River Hills Community Health Center Inc. | Past |
Accepting new patients |
Locations
509 N Madison St
Bloomfield, IA 52537
Phone (641) 664-2145
417 S East St
Corydon, IA 50060
Phone (641) 872-2260
417 S East St
Ste Er
Corydon, IA 50060
699 Walnut St
Ste 4
Des Moines, IA 50309
Phone (515) 278-9920
210 4th Ave
Grinnell, IA 50112
Phone (641) 236-2055
202 4th Ave
Ste 100
Grinnell, IA 50112
Phone (641) 236-2323
800 S Fillmore St
Ste A
Osceola, IA 50213
Phone (641) 342-2128
800 S Fillmore St
Osceola, IA 50213
Phone (641) 342-2184
1005 Pennsylvania Ave
Ste 102A
Ottumwa, IA 52501
Phone (641) 684-2589
1001 Pennsylvania Ave
Ottumwa, IA 52501
Phone (641) 472-4111
610 10th St
Perry, IA 50220
Phone (515) 465-3547
5950 University Ave
Ste 105
West Des Moines, IA 50266
Phone (515) 875-9070
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 097156 | IA | |
| Family Nurse Practitioner | 363LF0000X | A097156 | IA | |
| Nurse Practitioner | 363L00000X | A097156 | IA | Yes |
Addresses
Primary practice location
1015 N 18TH St
Centerville, IA 52544-1170
Mailing address
PO Box 458
Ottumwa, IA 52501-0458
Phone (641) 684-6896
Other practice location 1
5950 University Ave Ste 105
West Des Moines, IA 50266-7756
Phone (515) 875-9070
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3254342 | Medicaid | IA | |
| 36504 | Other | IA | WELLMARK BCBS OF IA |
| 420681060C4 | Other | IA | JOHN DEERE HEALTH |
Other providers in Centerville, IA
- Nancy Barton
- Narendra K. Batra
- Rajni Batra
- Carol Belloma
- Douglas Billingsley
- Janette Ruth Boggs
- Mary E Booth
- Rebecca Gail Bowen
- Patrick Bredar
- Kieron James Broderick
All providers in Centerville, IA · Nurse Practitioner in Iowa
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 29, 2023. 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).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.