Healthcare Provider Details

I. General information

NPI: 1891615225
Provider Name (Legal Business Name): JENNIFER KRISTEN BLAIR CSFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4050 BRIARGATE PKWY
COLORADO SPRINGS CO
80920-7815
US

IV. Provider business mailing address

4465 CHAMPIONS VW APT 110
COLORADO SPRINGS CO
80923-7380
US

V. Phone/Fax

Practice location:
  • Phone: 719-364-5000
  • Fax:
Mailing address:
  • Phone: 515-890-8802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number176421
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: