Healthcare Provider Details

I. General information

NPI: 1962312421
Provider Name (Legal Business Name): KRISTIN BLAIR
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 PAWNEE
EDMOND OK
73013-7722
US

IV. Provider business mailing address

3801 PAWNEE
EDMOND OK
73013-7722
US

V. Phone/Fax

Practice location:
  • Phone: 405-708-9505
  • Fax:
Mailing address:
  • Phone: 405-708-9505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR0099428
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: