Shakia Mary Blount-Williams, CRNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

SP018631 Issued in PA

Practice address

100 E Lancaster Ave Ste 330
Wynnewood, PA 19096

Phone

(610) 645-6555

Fax

(610) 649-4744

NPI assigned

Apr 25, 2018

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 PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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 and National Provider Directory roles.

• Main Line Healthcare

  • Family Medicine Physician
  • Newtown Square, PA
  • NPI 1922077643
  Medicare reassignment NPD

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

{
    "created_epoch": "1524614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529020800000",
    "number": "1902394968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 E LANCASTER AVE STE 330",
            "city": "WYNNEWOOD",
            "state": "PA",
            "postal_code": "190963443",
            "telephone_number": "610-645-6555",
            "fax_number": "610-649-4744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 E LANCASTER AVE STE 330",
            "city": "WYNNEWOOD",
            "state": "PA",
            "postal_code": "19096",
            "telephone_number": "610-645-6555",
            "fax_number": "610-649-4744"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLOUNT-WILLIAMS",
        "first_name": "SHAKIA",
        "middle_name": "MARY",
        "name_prefix": "Mrs.",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-25",
        "last_updated": "2018-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "PA",
            "license": "SP018631",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pradeep K Bhagat, M.D.
• Beth Bickel, LMFT
• Bio-Medical Applications of Pennsylvania, Inc.
• Rima Bishar, M.D.
• Eric Devins Block, RDN
• Tyler Lawson Bogaczyk, MD
• Anne Marie Boguslavsky
• Stacylynne Bolks, FNP-BC
• Gregory C. Bolton Sr., M.D.
• Kathryn Marie Bormes

• Family Nurse Practitioner in Wynnewood, PA
• Providers in Wynnewood, PA by specialty
• Family Nurse Practitioner in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.