Provider Demographics
NPI:1497905590
Name:BLACKWELL, DEBORAH A (MSN, RN, FNP-C)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:A
Last Name:BLACKWELL
Suffix:
Gender:F
Credentials:MSN, RN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 BIRCHLAWN DR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-6333
Mailing Address - Country:US
Mailing Address - Phone:314-607-8777
Mailing Address - Fax:
Practice Address - Street 1:1 JEFFERSON BARRACKS RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63125-4181
Practice Address - Country:US
Practice Address - Phone:314-652-4100
Practice Address - Fax:314-894-6594
Is Sole Proprietor?:No
Enumeration Date:2008-09-24
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO123558363L00000X, 163W00000X, 163WD1100X, 163WN0300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No163WD1100XNursing Service ProvidersRegistered NurseDialysis, Peritoneal
No163WN0300XNursing Service ProvidersRegistered NurseNephrology
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily