BLACKWELL, JAMES (NP)

Provider Demographics

• NPI: 1427036672
• Name: BLACKWELL, JAMES (NP)
• Entity Type: Individual
• First Name: JAMES
• Last Name: BLACKWELL
• Gender: M
• Credentials: NP
• Mailing Address - Street 1: PO BOX 19305
• Mailing Address - City: CHARLOTTE
• Mailing Address - State: NC
• Mailing Address - Zip Code: 28219-9305
• Mailing Address - Country: US
• Practice Address - Street 1: 1000 BLYTHE BLVD
• Practice Address - Street 2: CMC ANNEX 1ST FLOOR
• Practice Address - City: CHARLOTTE
• Practice Address - State: NC
• Practice Address - Zip Code: 28203-5812
• Practice Address - Country: US
• Practice Address - Phone: 704-355-0720
• Is Sole Proprietor?: No
• Enumeration Date: 2006-01-06
• Last Update Date: 2020-04-20

Provider Licenses

State	License ID	Taxonomies
NC	201660	363L00000X
NC	185139	363LF0000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	363LF0000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Family
Yes	363L00000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner

Provider Identifiers

State	Identifier ID	ID Type	Issuer
NC	2807612C	Other	MEDICARE PTAN, INDIVIDUAL
NC	1427036672	Medicaid
SC	NP0170	Medicaid
NC	232009	Other	MEDICARE PTAN, GROUP
NC	7000444	Medicaid
NC	2807612N	Medicare PIN
NC	2807612J	Medicare PIN
NC	2807612P	Medicare PIN
NC	2807612S	Medicare PIN
NC	2807612B	Medicare PIN
NC	232009	Other	MEDICARE PTAN, GROUP
NC	2807612R	Medicare PIN
NC	2807612A	Medicare PIN
NC	2807612F	Medicare PIN
NC	2807612C	Other	MEDICARE PTAN, INDIVIDUAL
NC	2807612A	Medicare UPIN
SC	NP0170	Medicaid
	2807612G	Medicare PIN
NC	2807612I	Medicare PIN
NC	NCA029	Medicare PIN
NC	1427036672	Medicaid
	2807612H	Medicare PIN
NC	2807612L	Medicare PIN
NC	2807612M	Medicare PIN
NC	NCA029A	Medicare PIN