MEDICARE: DEBORAH A BLACKWELL MSN, RN, FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	123558	MO
2	163W00000X	Registered Nurse	123558	MO
3	163WD1100X	Peritoneal Dialysis Registered Nurse	123558	MO
4	163WN0300X	Nephrology Registered Nurse	123558	MO
5	363LF0000X	Family Nurse Practitioner	123558	MO

General Provider Information

NPI Number	:	1497905590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH A BLACKWELL MSN, RN, FNP-C

Provider Business Mailing Address
First Line	:	240 BIRCHLAWN DR
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63033-6333
Country	:	US
Telephone Number	:	314-607-8777
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 JEFFERSON BARRACKS RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63125-4181
Country	:	US
Telephone Number	:	314-652-4100
Fax Number	:	314-894-6594

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/24/2008
Last Update Date	:	03/18/2024

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Directions to “ DEBORAH A BLACKWELL MSN, RN, FNP-C” Practice Location

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