Nicke Theresa Blackburn, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

D6953 Issued in TX

Practice address

5429 Ashby St
Houston, TX 77005-1721

Phone

(713) 529-2405

NPI assigned

May 30, 2008

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Dr. Theresa Nicholson Blackburn Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1212105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1212105600000",
    "number": "1932367455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5429 ASHBY ST",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770051721",
            "telephone_number": "713-529-2405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5429 ASHBY ST",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770051721",
            "telephone_number": "713-529-2405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKBURN",
        "first_name": "NICKE",
        "middle_name": "THERESA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-05-30",
        "last_updated": "2008-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "TX",
            "license": "D6953",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "THERESA",
            "last_name": "BLACKBURN",
            "middle_name": "NICHOLSON",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Troy Austin Black, MD
• Carl Joseph Blackburn, O.D.
• Jamie Blackburn, MA, LPC
• Kyle Warren Blackburn, MD
• Laura Blackburn, PHARMD
• Payton Blackburn, MD
• Savannah Blackburn
• Spiros Lee Blackburn, M.D.
• Blackbyrd the Carrier Company
• Blackcar Medical

• Psychiatry Physician in Houston, TX
• Providers in Houston, TX by specialty
• Psychiatry Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2008; 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.