Provider Demographics
NPI:1962130294
Name:BLAIR, KRISTEN (NP)
Entity type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:
Last Name:BLAIR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5720 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-2259
Mailing Address - Country:US
Mailing Address - Phone:228-697-3431
Mailing Address - Fax:
Practice Address - Street 1:1801 GOVERNMENT ST
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-3964
Practice Address - Country:US
Practice Address - Phone:228-200-6869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-14
Last Update Date:2022-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS905440363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner