Provider Demographics
NPI:1326520511
Name:PERSYN, BLAIR (MS, RDN, LDN, CNSC)
Entity Type:Individual
Prefix:
First Name:BLAIR
Middle Name:
Last Name:PERSYN
Suffix:
Gender:F
Credentials:MS, RDN, LDN, CNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2186 JACKSON KELLER RD
Mailing Address - Street 2:STE 1074
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-2723
Mailing Address - Country:US
Mailing Address - Phone:512-200-4795
Mailing Address - Fax:
Practice Address - Street 1:2186 JACKSON KELLER RD
Practice Address - Street 2:STE 1074
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-2723
Practice Address - Country:US
Practice Address - Phone:512-200-4795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-04
Last Update Date:2022-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT85375133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered