Mrs Jessie Leyla Blackmon, CRNP is a medicare enrolled "Nurse Practitioner - Family" in Vestavia Hls, Alabama. She graduated from nursing school in 2020 and has 5 years of diverse experience with area of expertise as Nurse Practitioner. She is a member of the group practice Aqua Dermatology Of Alabama Pc and her current practice location is
1940 Stonegate Dr Ste 130, Vestavia Hls, Alabama. You can reach out to her office (for appointments etc.) via phone at
(205) 977-9876.
Mrs Jessie Leyla Blackmon is licensed to practice in Alabama (license number F09201154) and she also participates in the medicare program. She
accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1811460173.
Provider's Profile
| Full Name | Mrs Jessie Leyla Blackmon |
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| Gender | Female |
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| Speciality | Nurse Practitioner |
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| Experience | 5 Years |
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| Location | 1940 Stonegate Dr Ste 130, Vestavia Hls, Alabama |
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| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Mrs Jessie Leyla Blackmon graduated from nursing school in 2020
NPI Data:
- NPI Number: 1811460173
- Provider Enumeration Date: 01/09/2019
- Last Update Date: 01/22/2022
Medicare PECOS Information:
- PECOS PAC ID: 3375947856
- Enrollment ID: I20210805000345
Medical Identifiers
Medical identifiers for Mrs Jessie Leyla Blackmon such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1811460173 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 163W00000X | Registered Nurse | 1-162172 (Alabama) | Secondary |
| 363LF0000X | Nurse Practitioner - Family | F09201154 (Alabama) | Primary |
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
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| Aqua Dermatology Of Alabama Pc | 9436211463 | 38 |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Mrs Jessie Leyla Blackmon allows following entities to bill medicare on her behalf.
| Entity Name | Aqua Dermatology Of Alabama Pc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1477708642
PECOS PAC ID: 9436211463
Enrollment ID: O20081229000234 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mrs Jessie Leyla Blackmon is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Mrs Jessie Leyla Blackmon, CRNP
1940 Stonegate Dr Ste 130,
Vestavia Hls, AL 35242-2541
Ph: (205) 977-9876 | Mrs Jessie Leyla Blackmon, CRNP
1940 Stonegate Dr Ste 130,
Vestavia Hls, AL 35242-2541
Ph: (205) 977-9876 |
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