Provider Demographics
NPI:1073055901
Name:BLAIR, MICHELE DEANN (APRN, NP-C)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:DEANN
Last Name:BLAIR
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Gender:F
Credentials:APRN, NP-C
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Mailing Address - Street 1:67 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-5619
Mailing Address - Country:US
Mailing Address - Phone:270-554-8373
Mailing Address - Fax:270-554-8987
Practice Address - Street 1:200 CLINIC DR # 6
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-1661
Practice Address - Country:US
Practice Address - Phone:812-477-7246
Practice Address - Fax:270-554-8987
Is Sole Proprietor?:No
Enumeration Date:2016-11-09
Last Update Date:2023-11-30
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Provider Licenses
StateLicense IDTaxonomies
KY3010855208VP0014X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine