Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Carly Jean Blasingame, CPNP-PC

Individual provider Primary Care Nurse Practitioner · NPI 1104504984

Carly Jean Blasingame, CPNP-PC is a Primary Care Nurse Practitioner in Fort Worth, Texas. Licensed in Texas. Registered with an NPI since 2023.

Licensed in
TX
In the registry since
2023
Specialties on file
2

Practice location Address checks out

1500 Cooper St
Fort Worth, TX 76104-2710
Phone: (682) 885-2500
Fax: (682) 885-2510
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Primary Care Nurse Practitioner (primary) Taxonomy 363LP2300X · Licence 1127441 (TX)
Pediatric Nurse Practitioner Taxonomy 363LP0200X · Licence 1127441 (TX)

Record details

NPI number1104504984
Entity typeIndividual (Type 1)
GenderFemale
Credentials CPNP-PC
Sole proprietorNo
NPI enumeratedJuly 10, 2023
Last updated in NPPESApril 6, 2026
Certification dateApril 6, 2026

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