NANCI JACQULYN SULLIVAN-BLACKERT


Address: 3604 Bush St, Raleigh, NC 27609-7511
Phone: 9198767807

NANCI JACQULYN SULLIVAN-BLACKERT (NPI# 1568718336) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1568718336
Entity Type Individual
Full Name NANCI JACQULYN SULLIVAN-BLACKERT
Other Name NANCI SULLIVAN BLACKERT
Credential RN, MSN, CDE, NP-C
Practice Address 3604 Bush St
Raleigh
NC 27609-7511
Practice Telephone 9198767807
Practice Fax Number 9194598402
Mailing Telephone 9198767807
Mailing Fax Number 9194598402
Enumeration Date 2012-07-31
Last Update Date 2016-08-11
Gender Code F
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 363LF0000X Nurse Practitioner
Specialization: Family
5005832 NC Physician Assistants & Advanced Practice Nursing Providers
N 363LF0000X Nurse Practitioner
Specialization: Family
F0512372 NC Physician Assistants & Advanced Practice Nursing Providers

Other Provider Identifier

State Issuer Identifier Type Code
HNFS/TRICARE 1568718336 01
NC FIRST CAROLINA CARE, INC FH4001480 01
NC FIRST MEDICARE DIRECT FH4001480 01
NC 1568718336 05

Office Location

Street Address 3604 BUSH ST
City RALEIGH
State NC
Zip Code 27609-7511

Providers in the same location

NPI Name Taxonomy Address Enumeration
1891797049 Wake Nephrology Associates, P.a. Specialist 3604 Bush St, Raleigh, NC 27609-7511 2005-06-01
1770901993 Sarah Mistrot Physician Assistant 3604 Bush St, Raleigh, NC 27609-7511 2014-04-03
1508299777 Shannon Joan Clark Nurse Practitioner 3604 Bush St, Raleigh, NC 27609-7511 2013-08-12
1699069948 Robert Edward Olivo Internal Medicine 3604 Bush St, Raleigh, NC 27609-7511 2011-06-03
1679885107 Lori Michelle Haskins Nurse Practitioner 3604 Bush St, Raleigh, NC 27609-7511 2010-07-13
1376602391 Deborah B Berg Dietitian, Registered 3604 Bush St, Raleigh, NC 27609-7511 2006-12-06
1780796508 Bio-medical Applications of North Carolina, Inc. Clinic/Center 3604 Bush St, Raleigh, NC 27609-7511 2006-08-31
1386752228 Jacqueline Suzanne Sebastian Nurse Practitioner 3604 Bush St, Raleigh, NC 27609-7511 2006-08-29
1366470791 Donna Antonia Theodore Physician Assistant 3604 Bush St, Raleigh, NC 27609-7511 2006-06-28
1689612442 Jessica J Oneill Physician Assistant 3604 Bush St, Raleigh, NC 27609-7511 2006-06-03
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
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1821612706 Helen Alexandra Bonner Physical Medicine & Rehabilitation Hey Clinic Pa, 3320 Wake Forest Road Ste 450, Raleigh, NC 27609 2020-06-05
1215423579 Appiah Nana Larbi Social Worker Easter Seals Ucp 4000 Wake Forest Rd Ste 200, Raleigh, NC 27609 2018-07-10
1215423777 Broadway Home Care LLC In Home Supportive Care 107 Windel Dr Ste 105, Raleigh, NC 27609 2018-07-09
1275027948 Lacey Allene Cottingham Social Worker 312 W Millbrook Rd Ste 129, Raleigh, NC 27609 2018-06-18
1447748819 Integrated Dermatology of North Raleigh, Pllc Dermatology 3809 Computer Dr Ste 200, Raleigh, NC 27609 2018-05-01
1902325418 Naomi Christine Askew Nurse Practitioner 3400 Wake Forest Drive, Bldg 9, Bldg #9, 4th Floor, Raleigh, NC 27609 2017-09-15
1962929679 Alexia Montague Social Worker 1306 Paddock Drive Suite E-100, Raleigh, NC 27609 2017-08-23
1730602236 Chantel Washington-mbuthia Counselor 1100 Logger Ct. Ste C100, Heartfelt Alternative Inc, Raleigh, NC 27609 2017-07-18
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Taxonomy Information

Taxonomy Code 363LF0000X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Nurse Practitioner
Specialization Family

Taxonomy Definition

Definition to come...

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NPI Name Taxonomy Address Enumeration
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1710598644 Nicole Dora Licato Nurse Practitioner 7200 Creedmoor Rd Ste 208, Raleigh, NC 27613-1711 2020-08-13
1316561178 Mintoria Lynette Stockton Nurse Practitioner 8332 Mcguire Dr, Raleigh, NC 27616-5682 2020-06-07
1700407103 Sadonna Marlene Sawyer Nurse Practitioner 3311 Grove Crabtree Cres Apt 122, Raleigh, NC 27613-3063 2020-04-27
1447879903 Christapher Frank Nurse Practitioner 2034 Wesvill Court, Suite 320, Raleigh, NC 28326 2020-04-14
1265065015 Shubham Tyagi Nurse Practitioner Duke Urgent Care Brier Creek, 10211 Alm Street Suite 1200, Raleigh, NC 27617-2761 2020-02-20
1073163812 Taylor Brooke Lawrence Nurse Practitioner 10208 Cerny St Ste 301, Raleigh, NC 27617-1000 2019-09-13
1811456320 Elizabeth Campbell Mcgrath Nurse Practitioner 2615 Lake Dr Ste 201, Raleigh, NC 27607-6694 2019-03-14
1922578541 Dorothy Nwizu Nurse Practitioner 608 Kavkaz St, Raleigh, NC 27610-3176 2018-11-26
1265900013 Patricia-marie Edge Odom Nurse Practitioner 3000 New Bern Ave Ste G100, Raleigh, NC 27610-1231 2018-11-09
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Competitor

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City RALEIGH
Zip Code 27609

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Dataset Information

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.

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