MEDICARE: KATHRYN ANNE BLAIR APRN BC FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	52207	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336139336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN ANNE BLAIR APRN BC FNP

Provider Business Mailing Address
First Line	:	1625 MEDICAL CENTER PT STE 190
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-8721
Country	:	US
Telephone Number	:	719-955-6000
Fax Number	:	710-955-9595

Provider Business Practice Location Address
First Line	:	1625 MEDICAL CENTER PT STE 190
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-8721
Country	:	US
Telephone Number	:	719-955-6000
Fax Number	:	719-955-9595

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	11/11/2010

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