Mia Lynnae Blackshear, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

152393 Issued in OH

Practice address

1827 Holburn Ave
Columbus, OH 43207-1681

Phone

(614) 599-9687

NPI assigned

Aug 2, 2011

Last updated

Apr 15, 2015By 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 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1312243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1429056000000",
    "number": "1902184328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1827 HOLBURN AVE",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432071681",
            "telephone_number": "614-599-9687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1827 HOLBURN AVE",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432071681",
            "telephone_number": "614-599-9687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKSHEAR",
        "first_name": "MIA",
        "middle_name": "LYNNAE",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-08-02",
        "last_updated": "2015-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "376K00000X",
            "taxonomy_group": "",
            "desc": "Nurse's Aide",
            "state": "OH",
            "license": "401195000111",
            "primary": false
        },
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "OH",
            "license": "152393",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0061631",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John D Blackman, MD
• Miricle Blackman
• Tammy Marie Blackmon, APRN-CNP
• Emily Renee Blackmore, CNP
• Jozette Blackshear
• Angela Blackstone, R.D.
• Ciara L Blackstone, LMT
• Symone Rhae Blackwell-Hill
• Alice Mae Blackwell
• Faith Blackwell, LPN

• Licensed Practical Nurse in Columbus, OH
• Providers in Columbus, OH by specialty
• Licensed Practical Nurse in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2015; 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.