Healthcare Provider Details

I. General information

NPI: 1487396750
Provider Name (Legal Business Name): REBEKAH ELIZABETH BLAIR APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2022
Last Update Date: 01/14/2023
Certification Date: 01/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2707 JACKSBORO PIKE STE 1A
JACKSBORO TN
37757-2752
US

IV. Provider business mailing address

2707 JACKSBORO PIKE STE 1A
JACKSBORO TN
37757-2752
US

V. Phone/Fax

Practice location:
  • Phone: 423-907-8186
  • Fax: 423-907-8187
Mailing address:
  • Phone: 423-907-8186
  • Fax: 423-907-8187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number33168
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number0000256293
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: