BLAIR SHEALY (NPI# 1972070662) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972070662 |
| Entity Type | Individual |
| Full Name | BLAIR SHEALY |
| Practice Address |
4077 5th Ave San Diego CA 92103-2105 |
| Mailing Address |
10140 Campus Point Dr San Diego CA 92121-1520 |
| Practice Telephone | 6192948111 |
| Mailing Telephone | 6192948111 |
| Enumeration Date | 2018-10-31 |
| Last Update Date | 2020-04-13 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207R00000X | Internal Medicine | 95010273 | CA | Allopathic & Osteopathic Physicians |
| Y | 363L00000X | Nurse Practitioner | NPF95010273 | CA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
4077 5TH AVE |
| City | SAN DIEGO |
| State | CA |
| Zip Code | 92103-2105 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932100062 | Julian George Lis | Emergency Medicine | 4077 5th Ave, San Diego, CA 92103-2105 | 2005-08-10 |
| 1154921195 | Michelle Miller | Social Worker | 4077 5th Ave, San Diego, CA 92103-2105 | 2020-10-29 |
| 1356972798 | Andrew Nasseri Md Inc. | Surgery | 4077 5th Ave, San Diego, CA 92103-2105 | 2020-02-03 |
| 1134769573 | Emi Harris | Nurse Practitioner | 4077 5th Ave, San Diego, CA 92103-2105 | 2020-01-14 |
| 1669012217 | Justin Jerluen Lin | Pharmacist | 4077 5th Ave, Mer 52, San Diego, CA 92103 | 2020-01-12 |
| 1487143749 | Jovian W Lam | Internal Medicine | 4077 5th Ave, San Diego, CA 92103 | 2018-05-02 |
| 1316452303 | Meghan Murphy | Social Worker | 4077 5th Ave, San Diego, CA 92103-2105 | 2017-12-12 |
| 1508390394 | Kristina Strong | Nurse Practitioner | 4077 5th Ave, San Diego, CA 92103-2105 | 2017-04-18 |
| 1124578117 | Jennifer Agueda | Nurse Practitioner | 4077 5th Ave, San Diego, CA 92103-2105 | 2016-10-13 |
| 1013309962 | Brody Tucker | Social Worker | 4077 5th Ave, San Diego, CA 92103-2105 | 2015-03-02 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174140057 | Carmel Agdeppa | Acupuncturist | Chiropractique, 813 West Washington St., San Diego, CA 92103 | 2020-06-26 |
| 1568082717 | Salina Ann Bambic | Social Worker | 302 Washington Street Suite 420, San Diego, CA 92103 | 2020-04-17 |
| 1467099432 | Lina Hong | Behavior Technician | 3731 6th Ave. Suite 100, San Diego, Ca 92103, San Diego, CA 92103 | 2019-12-09 |
| 1154964567 | Rodger Stacy Questin, Psychologist P.C. | Psychologist | 440 Upas St Apt 402, San Diego, CA 92103 | 2019-10-18 |
| 1932740388 | Grace Tong-ventura | Pharmacist | 200 W. Arbor Drive, #8765, Suite 1-317, San Diego, CA 92103 | 2019-10-07 |
| 1306490453 | Genevieve Cheung | Pharmacist | 200 W Arbor Dr #8765, Department of Pharmacy, San Diego, CA 92103 | 2019-07-26 |
| 1801356837 | Marika Doviak | Acupuncturist | 2370 Hickory St, San Diego, CA 92103 | 2019-03-25 |
| 1982185070 | Tyler Lewis Roberts | Counselor | 4303 3rd Ave, San Diego, CA 92103 | 2018-08-27 |
| 1689151284 | Tori Breanne Blackwell | Occupational Therapist | 3731-a 6th Avenue, San Diego, CA 92103 | 2018-07-26 |
| 1952892614 | Pacific Bay Recovery Inc | Substance Abuse Rehabilitation Facility | 4095 Jackdaw St, San Diego, CA 92103 | 2018-05-29 |
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| Taxonomy Code | 363L00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. |
| Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417560467 | Helen Regina Stearns | Nurse Practitioner | 8797 Encino Ave, San Diego, CA 92123-3952 | 2020-08-28 |
| 1346852480 | Jenna Juenger | Nurse Practitioner | 10665 Calle Mar De Mariposa Apt 3215, San Diego, CA 92130-8730 | 2020-08-19 |
| 1750908414 | Deborah Lynne Monaghan | Nurse Practitioner | 14471 Via Venezia Apt 601, San Diego, CA 92129-1657 | 2020-06-29 |
| 1780211300 | Amanda Renee Phillips | Nurse Practitioner | 3034 Horton Ave, San Diego, CA 92103-6008 | 2020-03-24 |
| 1538792304 | Allison D White | Nurse Practitioner | 726 W Pennsylvania Ave, San Diego, CA 92103-3804 | 2020-02-19 |
| 1356981351 | Jordan Rae Burke | Nurse Practitioner | 11943 El Camino Real Ste 100, San Diego, CA 92130-2597 | 2020-01-08 |
| 1598319436 | Madison Taylor Shreeve | Nurse Practitioner | 3435 Del Mar Heights Rd # D6a, San Diego, CA 92130-2225 | 2019-07-29 |
| 1659930485 | Lovella Medilo | Nurse Practitioner | 4033 3rd Ave Ste 430, San Diego, CA 92103-2117 | 2019-06-05 |
| 1306300272 | Stephanie O'brien Sramek | Nurse Practitioner | 4077 5th Ave # Ems, San Diego, CA 92103-2105 | 2019-01-25 |
| 1467930875 | Reliable Care Md On The Go | Nurse Practitioner | 4565 Ruffner St Ste 201, San Diego, CA 92111-2259 | 2018-07-30 |
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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.