Christian Constance Blackwell, RN MSN NP-C

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

APRN9171045 Issued in FL

Practice address

1005 Mar Walt Drive
Internal Medicine Department
Fort Walton Beach, FL 32547-6707

Phone

(850) 863-8202

Fax

(850) 862-6148

NPI assigned

Apr 9, 2015

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

Other names 1

• Christian Constance Carroll Former name

Medicare fee-for-service enrollment

Enrolled in FL

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

Specialty

Nurse Practitioner

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Gulf Coast Immediate Care Center Inc.Group PAC ID 9638172745, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing, Nurse Practitioner, Registered Nurse

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/8204/brand/1/csg/1/fhir/r4
• Direct secure messaging: christian.blackwell.1@8204.direct.athenahealth.com

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.

• Gulf Coast Immediate Care Center Inc.

  • Primary Care Clinic/Center
  • Fort Walton Beach, FL
  • NPI 1437113057
  Medicare reassignment Care Compare group NPD
• Quality Urgent Care & Wellness PL

  • Urgent Care Clinic/Center
  • Fort Walton Beach, FL
  • NPI 1861824013
  Medicare reassignment NPD
• Quality Urgent Care & Wellness PL

  • Urgent Care Clinic/Center
  • Pensacola, FL
  • NPI 1033562913
  NPD

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

{
    "created_epoch": "1428537600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569369600000",
    "number": "1922494657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1005 MAR WALT DR",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325476707",
            "telephone_number": "850-863-8100",
            "fax_number": "850-863-8548"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1005 MAR WALT DRIVE",
            "address_2": "INTERNAL MEDICINE DEPARTMENT",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325476707",
            "telephone_number": "850-863-8202",
            "fax_number": "850-862-6148"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKWELL",
        "first_name": "CHRISTIAN",
        "middle_name": "CONSTANCE",
        "credential": "RN MSN NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-04-09",
        "last_updated": "2019-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "APRN9171045",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CHRISTIAN",
            "last_name": "CARROLL",
            "middle_name": "CONSTANCE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Gwendolyn Black
• Monica W Black, LMHC
• Katherine Blackburn
• Laurel Blackerby
• Savannah Shirley Blacklidge, MS CY SLP
• Blanca Peak Inpatient Services LLC
• Robert Neil Blanchard, MD
• BLC Wellington - Fort Walton Beach, LLC
• BLC Westwood LLC
• Blessing Upon Blessing

• Nurse Practitioner in Fort Walton Beach, FL
• Providers in Fort Walton Beach, FL by specialty
• Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2019; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.