Provider Demographics
NPI:1487396750
Name:BLAIR, REBEKAH ELIZABETH (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:ELIZABETH
Last Name:BLAIR
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2707 JACKSBORO PIKE STE 1A
Mailing Address - Street 2:
Mailing Address - City:JACKSBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37757-2752
Mailing Address - Country:US
Mailing Address - Phone:423-907-8186
Mailing Address - Fax:423-907-8187
Practice Address - Street 1:2707 JACKSBORO PIKE STE 1A
Practice Address - Street 2:
Practice Address - City:JACKSBORO
Practice Address - State:TN
Practice Address - Zip Code:37757-2752
Practice Address - Country:US
Practice Address - Phone:423-907-8186
Practice Address - Fax:423-907-8187
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-08
Last Update Date:2023-01-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN0000256293163WH0200X
TN33168363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No163WH0200XNursing Service ProvidersRegistered NurseHome Health