MEDICARE: AUDRA KAY BLAIR BHCM II

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175T00000X	Peer Specialist
2	171M00000X	Case Manager/Care Coordinator

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871831214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUDRA KAY BLAIR BHCM II

Provider Business Mailing Address
First Line	:	7824 NW 83RD ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73132-3305
Country	:	US
Telephone Number	:	405-830-5732
Fax Number	:	405-726-8967

Provider Business Practice Location Address
First Line	:	7824 NW 83RD ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73132-3305
Country	:	US
Telephone Number	:	405-830-5732
Fax Number	:	405-367-7635

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2013
Last Update Date	:	02/17/2017

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