NPI 1790808681 · live from the CMS NPI Registry
Anita Jane Blackwell, RNCPNP
Nurse Practitioner, Pediatrics in Saint Louis, MO. National Provider Identifier 1790808681, active.
NPI record
| NPI | 1790808681 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Nurse Practitioner, Pediatrics 363LP0200X |
| Practice location | 4055 Lindell Blvd, Saint Louis, MO 63108 |
| Practice phone | 314-535-7701 |
| Mailing address | 12377 Merit Dr Ste 300, Dallas, TX 75251 |
| Enumerated | April 7, 2007 |
| Last updated | September 22, 2022 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Nurse Practitioner, Pediatrics | 363LP0200X | AP133887 (TX) |
| Nurse Practitioner, Pediatrics primary | 363LP0200X | 061036 (MO) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.