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General NPI Number Information
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NPI Number | 1235457631
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Entity Type | Individual
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Provider Name | JENNIFER BLAYLOCK NP
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Gender | Female
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Dates
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Enumeration Date | 05/10/2010
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Last Update Date | 01/20/2023
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Provider Practice Location Address
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Address Line | 3591 MCKINNEY ST STE 100
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City | MELISSA
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State | TX
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Zip | 75454
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Country | US
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Telephone | 972-837-1075
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Fax | 972-837-4120
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Provider Business Mailing Address
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Address Line | 3591 MCKINNEY ST STE 100
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City | MELISSA
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State | TX
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Zip | 75454-9572
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Country | US
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Telephone | 972-837-1075
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Fax | 972-837-4120
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 041353149
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 898686
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 209-008242
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP131058
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License Number State | TX
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