Jerry D Blaylock, M.D.

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

C4264 Issued in AR

Practice address

901 S Church St
Jonesboro, AR 72401-4105

Phone

(870) 935-0360

Fax

(870) 972-8603

NPI assigned

Jul 4, 2006

Last updated

Sep 22, 2011By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• St. Bernards Behavioral Health

  • Psychiatric Hospital
  • Jonesboro, AR
  • NPI 1073691481
  NPD (past)

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

{
    "created_epoch": "1151971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1316649600000",
    "number": "1922038975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 S CHURCH ST",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724014105",
            "telephone_number": "870-935-0360",
            "fax_number": "870-972-8603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 S CHURCH ST",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724014105",
            "telephone_number": "870-935-0360",
            "fax_number": "870-972-8603"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAYLOCK",
        "first_name": "JERRY",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-04",
        "last_updated": "2011-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "AR",
            "license": "C4264",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101644001",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carol Blansett, RN
• Taylor Nicole Blansett, LMSW
• Lexie Blanton
• David M Blaske, PHD
• Brian Douglas Blaylock
• Martye Murphy Blaylock, MSPT
• Blessed Hearts Home Health LLC
• Claudia Blevins, LPN
• Victor Blevins
• Shanika Blocker

• Mental Health Counselor in Jonesboro, AR
• Providers in Jonesboro, AR by specialty
• Mental Health Counselor in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2011; 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.