AMBER LAUREN BLACKNALL DNP, PMHNP - NPI 1447967435 - Nurse Practitioner in Albuquerque, NM

Q: What is the provider's specialty?

The provider's specialty is Nurse Practitioner with taxonomy code 363LP0808X and a focus in Psychiatric/Mental Health.

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About Amber Lauren Blacknall Dnp, Pmhnp NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

AMBER LAUREN BLACKNALL DNP, PMHNP (NPI 1447967435) is an individual psychiatric/mental health provider in Albuquerque, New Mexico, licensed in New Mexico (70510) and active in the NPI registry since October 2022. She has opted out of Medicare through September 18, 2026 and maintains a secondary practice location in Albuquerque.

NPPES Registry Identity

NPI1447967435

Entity TypeIndividualFemale

Primary Taxonomy363LP0808X

Provider Legal NameAMBER LAUREN BLACKNALLCredential: DNP, PMHNP

Location Address6612 GULTON CT NEAlbuquerque, NM 87109-4407

Mailing Address500 Marquette Ave Nw Ste 1219Albuquerque, NM 87102-5340 · (505) 316-5966 · Fax (505) 422-4073

Phone(505) 316-5966

Sole ProprietorYes

Enumeration DateOctober 31, 2022

Last NPPES UpdateFebruary 9, 20243 updates tracked since enumeration

NPPES CertifiedFebruary 9, 2024

✔ NPI 1447967435 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LP0808X

License✔ Licensed in NM · 70510

6612 GULTON CT NE, Albuquerque, NM 87109

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Secondary Practice Location 1

Location 1500 Marquette Ave NW Ste 1219Albuquerque, NM 87102-5340 · Phone (505) 316-5966

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Amber Lauren Blacknall Dnp, Pmhnp has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from September 18, 2024 through September 18, 2026.

Opt-Out Effective DateSeptember 18, 2024

Opt-Out In Effect ThroughSeptember 18, 2026Opt-out affidavits renew automatically every two years unless cancelled

Other Providers at the Same Location NPPES 6

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

LUCINDA REYES LCSW

Social Worker (Clinical)