Healthcare Provider Details

I. General information

NPI: 1033618772
Provider Name (Legal Business Name): BLAIRE WEATHERFORD MYERS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2018
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1213 N RANGE AVE
DENHAM SPRINGS LA
70726-2411
US

IV. Provider business mailing address

26754 HIGHWAY 441
KENTWOOD LA
70444-8145
US

V. Phone/Fax

Practice location:
  • Phone: 225-665-6677
  • Fax: 225-665-0055
Mailing address:
  • Phone: 225-910-0530
  • Fax: 225-665-0055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP09805
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: