Provider Demographics
NPI:1336139336
Name:BLAIR, KATHRYN ANNE (APRN BC FNP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ANNE
Last Name:BLAIR
Suffix:
Gender:F
Credentials:APRN BC FNP
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:ANNE
Other - Last Name:BOYD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1625 MEDICAL CENTER PT STE 190
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-8721
Mailing Address - Country:US
Mailing Address - Phone:719-955-6000
Mailing Address - Fax:710-955-9595
Practice Address - Street 1:1625 MEDICAL CENTER PT STE 190
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-8721
Practice Address - Country:US
Practice Address - Phone:719-955-6000
Practice Address - Fax:719-955-9595
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-21
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO52207363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07522041Medicaid
CO07522041Medicaid
S50688Medicare UPIN