Provider Demographics
NPI:1841019684
Name:MCMARTIN, BLAIR KERSTAN (NP)
Entity type:Individual
Prefix:
First Name:BLAIR
Middle Name:KERSTAN
Last Name:MCMARTIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:BLAIR
Other - Middle Name:KERSTAN
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2570 LAKE RIDGE RD APT 3303
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75056-4963
Mailing Address - Country:US
Mailing Address - Phone:432-559-9884
Mailing Address - Fax:
Practice Address - Street 1:1111 RAINTREE CIR STE 280
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-0135
Practice Address - Country:US
Practice Address - Phone:972-984-1050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1168777363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily