Healthcare Provider Details

I. General information

NPI: 1982463295
Provider Name (Legal Business Name): MRS. KAILYN PAIGE BLAIR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2024
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 JENNY LIND RD
FORT SMITH AR
72901-6735
US

IV. Provider business mailing address

2900 JENNY LIND RD
FORT SMITH AR
72901-6735
US

V. Phone/Fax

Practice location:
  • Phone: 479-222-1924
  • Fax: 479-358-1455
Mailing address:
  • Phone: 479-222-1924
  • Fax: 479-358-1455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number4736
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: