Provider Demographics
NPI:1790808681
Name:BLACKWELL, ANITA JANE (RNCPNP)
Entity Type:Individual
Prefix:MISS
First Name:ANITA
Middle Name:JANE
Last Name:BLACKWELL
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Gender:F
Credentials:RNCPNP
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Mailing Address - Street 1:12377 MERIT DR STE 300
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251-3126
Mailing Address - Country:US
Mailing Address - Phone:972-957-3000
Mailing Address - Fax:972-957-3005
Practice Address - Street 1:4055 LINDELL BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-3201
Practice Address - Country:US
Practice Address - Phone:314-535-7701
Practice Address - Fax:314-535-0207
Is Sole Proprietor?:No
Enumeration Date:2007-04-07
Last Update Date:2022-09-22
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Provider Licenses
StateLicense IDTaxonomies
TXAP133887363LP0200X
MO061036363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics