MEDICARE: JESSICA ANNE BLAIR PA-C

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	363A00000X	Physician Assistant	PA00390	MS

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	:	1881770378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA ANNE BLAIR PA-C

Provider Business Mailing Address
First Line	:	2101 HIGHWAY 90
Second Line	:
City	:	GAUTIER
State	:	MS
Zip	:	39553-5340
Country	:	US
Telephone Number	:	228-497-7576
Fax Number	:	228-497-8869

Provider Business Practice Location Address
First Line	:	1720A MEDICAL PARK DR STE 150
Second Line	:
City	:	BILOXI
State	:	MS
Zip	:	39532-2135
Country	:	US
Telephone Number	:	228-392-7429
Fax Number	:	228-396-3830

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

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	11/28/2023

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Directions to “ JESSICA ANNE BLAIR PA-C” Practice Location

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