Provider Demographics
NPI:1225503642
Name:BLAIR, TRISHA E (CNP)
Entity Type:Individual
Prefix:
First Name:TRISHA
Middle Name:E
Last Name:BLAIR
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3103 S TAFT ST
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-4427
Mailing Address - Country:US
Mailing Address - Phone:870-329-3028
Mailing Address - Fax:870-879-9387
Practice Address - Street 1:3103 S TAFT ST
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-4427
Practice Address - Country:US
Practice Address - Phone:870-329-3028
Practice Address - Fax:870-382-8190
Is Sole Proprietor?:No
Enumeration Date:2018-10-11
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005902363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily