Healthcare Provider Details

I. General information

NPI: 1124437769
Provider Name (Legal Business Name): JODI LYNN BLAIR CNM APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2014
Last Update Date: 07/07/2021
Certification Date: 07/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1109 SW TOPEKA BLVD
TOPEKA KS
66612-1602
US

IV. Provider business mailing address

1109 SW TOPEKA BLVD
TOPEKA KS
66612-1602
US

V. Phone/Fax

Practice location:
  • Phone: 785-232-6950
  • Fax: 785-232-4722
Mailing address:
  • Phone: 785-232-6950
  • Fax: 785-232-4722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number64016
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number53-64016-051
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number13-46953-051
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: