KATIE N BLALACK (NPI# 1497241343) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497241343 |
| Entity Type | Individual |
| Full Name | KATIE N BLALACK |
| Credential | DNP |
| Practice Address |
621 E Matthews Ave Jonesboro AR 72401 |
| Mailing Address |
621 E Matthews Ave Jonesboro AR 72401-3145 |
| Practice Telephone | 8709326799 |
| Mailing Telephone | 8709326799 |
| Mailing Fax Number | 8709328423 |
| Enumeration Date | 2018-07-03 |
| Last Update Date | 2018-07-23 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
A005779 | AR | Physician Assistants & Advanced Practice Nursing Providers |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| Street Address |
621 E MATTHEWS AVE |
| City | JONESBORO |
| State | AR |
| Zip Code | 72401 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851366140 | Joseph H Sales | Otolaryngology | 621 E Matthews Ave, Jonesboro, AR 72401-3145 | 2006-02-21 |
| 1114447000 | Hayley Himstedt | Audiologist | 621 E Matthews Ave, Jonesboro, AR 72401-3145 | 2017-06-22 |
| 1508395427 | Sarah Holland Benton | Audiologist | 621 E Matthews Ave, Jonesboro, AR 72401-3145 | 2017-06-05 |
| 1922425818 | Otolaryngology and Facial Surgery Center of Northeast Ark Pa | Audiologist-Hearing Aid Fitter | 621 E Matthews Ave, Jonesboro, AR 72401-3145 | 2014-03-28 |
| 1013359769 | Heather Stallings | Nurse Practitioner | 621 E Matthews Ave, Jonesboro, AR 72401-3145 | 2013-07-23 |
| 1497062509 | Mary C Criner | Audiologist | 621 E Matthews Ave, Jonesboro, AR 72401-3145 | 2010-09-10 |
| 1659340297 | Ne Arkansas Otolaryngology Facial Surgery P A | Otolaryngology | 621 E Matthews Ave, Jonesboro, AR 72401-3145 | 2006-03-16 |
| 1871568808 | John B Jiu | Otolaryngology | 621 E Matthews Ave, Jonesboro, AR 72401-3145 | 2006-02-22 |
| 1588639512 | David Lewis | Otolaryngology | 621 E Matthews Ave, Jonesboro, AR 72401-3145 | 2006-02-22 |
| 1538134572 | Shane R Smith | Otolaryngology | 621 E Matthews Ave, Jonesboro, AR 72401-3145 | 2006-02-22 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407453368 | Mariah Kay Jackson | Physical Therapy Assistant | Creative Kids Therapy, Jonesboro, AR 72401 | 2020-10-05 |
| 1821606005 | Kafayat Folake Iyanda | Specialist/Technologist | 2105 East Aggie Rd, Jonesboro, AR 72401 | 2020-07-14 |
| 1053936310 | Josh Roberts | Physical Therapist | 1010 South Main St, Jonesboro, AR 72401 | 2020-06-12 |
| 1003449687 | Amy Mary Elizabeth Daughhetee | Nurse Practitioner | 225 East Washington Ave, Jonesboro, AR 72401 | 2020-02-21 |
| 1871126698 | Sarah Lowtharp | Clinical Nurse Specialist | 225 East Washington Ave., Jonesboro, AR 72401 | 2020-02-20 |
| 1891335519 | Mallori Miller | Case Manager/Care Coordinator | 837 Willett Rd, Jonesboro, AR 72401 | 2020-01-10 |
| 1265073704 | Michael Bruce Collie | Registered Nurse | 837 Williett Road, Jonesboro, AR 72401 | 2019-10-07 |
| 1285283432 | Jonesboro Ambulatory Surgery Center, LLC | Clinic/Center | 1710 Mayfield Dr, Jonesboro, AR 72401 | 2019-09-10 |
| 1841843943 | Destinee Katrina Cole | Specialist/Technologist | 2015 Aggie Rd, Jonesboro, AR 72401 | 2019-07-18 |
| 1699250472 | Jessica Marie Mcnatt | Occupational Therapist | 907 County Road 753, Jonesboro, AR 72401 | 2018-09-27 |
| Find all providers in zip 72401 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457958233 | Kaitlyn Soffray Simmons | Nurse Practitioner | 500 Kitchen St, Jonesboro, AR 72401-3135 | 2020-10-05 |
| 1407463938 | Aleshia Williams | Nurse Practitioner | 5401 Clear Creek Ln, Jonesboro, AR 72404-7006 | 2020-09-29 |
| 1790397495 | Kbsolutions and Behavioral Support Services, LLC | Nurse Practitioner | 7265 Mount Zion Blvd Ste 1, Jonesboro, GA 30236-2519 | 2020-08-24 |
| 1568080646 | Maryam A Muhammad | Nurse Practitioner | 2388 Reeves Creek Rd, Jonesboro, GA 30236-7229 | 2020-07-06 |
| 1346864121 | Joy Brew | Nurse Practitioner | 8399 Members Dr, Jonesboro, GA 30236-4271 | 2020-06-08 |
| 1053932806 | Sabrina Nannettee Bowen | Nurse Practitioner | 5800 C W Post Rd, Jonesboro, AR 72401-9602 | 2020-05-04 |
| 1265993182 | Sara Ruth Johnson | Nurse Practitioner | 701 Windover Rd Ste 400, Jonesboro, AR 72401-6065 | 2019-03-26 |
| 1366927956 | Yolanda Louise Davis | Nurse Practitioner | 1706 Heather Ridge Dr, Jonesboro, AR 72401-3748 | 2018-09-28 |
| 1457867475 | Eucharia Udoka Obi | Nurse Practitioner | 9051 Jenni Cir, Jonesboro, GA 30238-6800 | 2017-12-28 |
| 1346752151 | Chanel Dominque Bullock | Nurse Practitioner | 1150 E Matthews Ave Ste 203, Jonesboro, AR 72401 | 2017-11-02 |
| Find all providers in JONESBORO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.