=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487396750
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REBEKAH ELIZABETH BLAIR APRN, FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/08/2022
-----------------------------------------------------
Last Update Date | 01/14/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2707 JACKSBORO PIKE STE 1A
-----------------------------------------------------
City | JACKSBORO
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37757-2752
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-907-8186
-----------------------------------------------------
Fax | 423-907-8187
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2707 JACKSBORO PIKE STE 1A
-----------------------------------------------------
City | JACKSBORO
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37757-2752
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-907-8186
-----------------------------------------------------
Fax | 423-907-8187
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 33168
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163WH0200X
-----------------------------------------------------
Taxonomy Name | Home Health Registered Nurse
-----------------------------------------------------
License Number | 0000256293
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------