Provider Demographics
NPI:1124416110
Name:TROUTMAN, BLAIR KEITH (PA-C)
Entity Type:Individual
Prefix:
First Name:BLAIR
Middle Name:KEITH
Last Name:TROUTMAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14330 OAKHILL PARK LN
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-3314
Mailing Address - Country:US
Mailing Address - Phone:704-316-1265
Mailing Address - Fax:
Practice Address - Street 1:14330 OAKHILL PARK LN
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-3314
Practice Address - Country:US
Practice Address - Phone:704-316-1265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-30
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-05453363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant