CAROLYN ANN BLACKBURN (NPI# 1902336431) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902336431 |
| Entity Type | Individual |
| Full Name | CAROLYN ANN BLACKBURN |
| Credential | FNP-C |
| Practice Address |
109 N Main St Braymer MO 64624-9325 |
| Mailing Address |
238 Sw 30th Ave Trenton MO 64683-8427 |
| Practice Telephone | 6606452218 |
| Practice Fax Number | 6606452820 |
| Mailing Telephone | 6606350755 |
| Enumeration Date | 2017-06-18 |
| Last Update Date | 2019-08-22 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163W00000X | Registered Nurse | 2008017992 | MO | Nursing Service Providers |
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
2017032960 | MO | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | 420047801 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 4401 Wornall Rd, Kansas City, MO 641113220 | 8169322000 | |
| 630 W 3rd St, Milan, MO 635561076 | 6602654212 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669472247 | Carolyn W Blackburn | Social Worker | 329 Bath Rd, Brunswick, ME 04011-2673 | 2005-07-26 |
| 1346325917 | Carolyn B Blackburn | Counselor | 349-a East Avenue K-6, Lancaster, CA 93535 | 2006-10-25 |
| Street Address |
109 N MAIN ST |
| City | BRAYMER |
| State | MO |
| Zip Code | 64624-9325 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043785470 | Katelynn R Crawford | Nurse Practitioner | 109 N Main St, Braymer, MO 64624-9325 | 2018-10-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215059209 | Northwest Health Services, Inc | Family Medicine | 109 Main Street, Braymer, MO 64624 | 2007-04-03 |
| 1033284955 | Daniel Scott Pennington | Chiropractor | 209 Main Street, Braymer, MO 64624 | 2006-11-24 |
| 1477520690 | Dorothy Milburn | Nurse Practitioner | 109 Main Street, Braymer, MO 64624-0036 | 2006-03-07 |
| 1043208796 | Golden Age Nursing Home District | Skilled Nursing Facility | 12498 Se Highway 116, Braymer, MO 64624-9107 | 2005-10-06 |
| 1588283196 | Hillary Marie Simpson | Physical Therapist | 12498 Se Highway 116, Braymer, MO 64624-9107 | 2020-04-14 |
| 1003013111 | Braymer C-4 School | Local Education Agency (LEA) | 400 Bobcat Ave, Braymer, MO 64624-9750 | 2007-07-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003013111 | Braymer C-4 School | Local Education Agency (LEA) | 400 Bobcat Ave, Braymer, MO 64624-9750 | 2007-07-02 |
| 1043208796 | Golden Age Nursing Home District | Skilled Nursing Facility | 12498 Se Highway 116, Braymer, MO 64624-9107 | 2005-10-06 |
| 1588283196 | Hillary Marie Simpson | Physical Therapist | 12498 Se Highway 116, Braymer, MO 64624-9107 | 2020-04-14 |
| 1215059209 | Northwest Health Services, Inc | Family Medicine | 109 Main Street, Braymer, MO 64624 | 2007-04-03 |
| 1033284955 | Daniel Scott Pennington | Chiropractor | 209 Main Street, Braymer, MO 64624 | 2006-11-24 |
| 1477520690 | Dorothy Milburn | Nurse Practitioner | 109 Main Street, Braymer, MO 64624-0036 | 2006-03-07 |
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043785470 | Katelynn R Crawford | Nurse Practitioner | 109 N Main St, Braymer, MO 64624-9325 | 2018-10-12 |
| 1477520690 | Dorothy Milburn | Nurse Practitioner | 109 Main Street, Braymer, MO 64624-0036 | 2006-03-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134720816 | Blake Christian Cory | Nurse Practitioner | 615 S Ballas Rd # 2015, Saint Louis, MO 63122-5314 | 2020-11-08 |
| 1336740620 | Courtney J Perkins | Nurse Practitioner | 724 Sw 30th St, Blue Springs, MO 64015-3381 | 2020-11-04 |
| 1467052381 | Kristin Nersesyan | Nurse Practitioner | 916 Sw Bennington Pl, Lees Summit, MO 64081-3700 | 2020-10-29 |
| 1265032346 | Sara Lynn Gillespie | Nurse Practitioner | 2424 S 9th St Apt 215, Saint Louis, MO 63104-4717 | 2020-10-28 |
| 1659971992 | Carrie Ellen Smith | Nurse Practitioner | Mailstop 90-00-174, One Barnes-jewish Plaza, St. Louis, MO 63110 | 2020-10-27 |
| 1417556994 | Tory Linn Francis | Nurse Practitioner | 19155 Fry Rd, Edgerton, MO 64444-9037 | 2020-10-26 |
| 1174123509 | Megan Ashley Wagner | Nurse Practitioner | 10012 Kennerly Rd Ste 406, Saint Louis, MO 63128-2197 | 2020-10-26 |
| 1033718903 | Lisa Jo Moore | Nurse Practitioner | 2623 S Main Street, Nixa, MO 64804 | 2020-10-22 |
| 1831798792 | Alicia Caroline Baker | Nurse Practitioner | 1070 W 7th St, Washington, MO 63090 | 2020-10-21 |
| 1114526266 | Leslie Desha | Nurse Practitioner | 1109 Pheasant Run, Columbia, MO 65201-6253 | 2020-10-20 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.