Healthcare Provider Details

I. General information

NPI: 1336007087
Provider Name (Legal Business Name): JOHN BLAIR APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 W FARM RD
STILLWATER OK
74078-2000
US

IV. Provider business mailing address

1202 W FARM RD
STILLWATER OK
74078-2000
US

V. Phone/Fax

Practice location:
  • Phone: 804-454-5320
  • Fax:
Mailing address:
  • Phone: 405-744-7665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number226940
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR0066267
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number226940
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: