Active NPI
Erica Danielle Blalock, NP
- Family Nurse Practitioner
- Fort Payne, AL
National Provider Identifier
1881095073
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 1131087
- Practice address
- 1359 Old Water Works Rd SW
Fort Payne, AL 35968-3347 - Phone
- (256) 997-5900
- Fax
- (256) 997-5995
- NPI assigned
- Sep 8, 2014
- Last updated
- Mar 31, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 1131087 | AL | Primary |
| Family Nurse Practitioner | 363LF0000X | 19028 | TN |
Addresses
Primary practice location
1359 Old Water Works Rd SW
Fort Payne, AL 35968-3347
Mailing address
1359 Old Water Works Rd SW
Fort Payne, AL 35968-3347
Phone (256) 997-5900
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 179228 | Medicaid | AL | |
| 1-131087 | Other | AL | ALABAMA NP/RN LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1131087 | AL | MD | Family Nurse Practitioner |
| 19028 | TN | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fort Payne Pediatrics LLC | Family | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1410134400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1490918400000",
"number": "1881095073",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1359 OLD WATER WORKS RD SW",
"city": "FORT PAYNE",
"state": "AL",
"postal_code": "359683347",
"telephone_number": "256-997-5900",
"fax_number": "256-997-5995"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1359 OLD WATER WORKS RD SW",
"city": "FORT PAYNE",
"state": "AL",
"postal_code": "359683347",
"telephone_number": "256-997-5900",
"fax_number": "256-997-5995"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLALOCK",
"first_name": "ERICA",
"middle_name": "DANIELLE",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-09-08",
"last_updated": "2017-03-31",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "AL",
"license": "1131087",
"primary": true
},
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "TN",
"license": "19028",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "179228",
"state": "AL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ALABAMA NP/RN LICENSE",
"identifier": "1-131087",
"state": "AL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Payne, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.