Provider Demographics
NPI:1336493691
Name:BLAIR, ANALYN K (NP)
Entity Type:Individual
Prefix:
First Name:ANALYN
Middle Name:K
Last Name:BLAIR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 830230
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35283-0230
Mailing Address - Country:US
Mailing Address - Phone:205-250-6000
Mailing Address - Fax:
Practice Address - Street 1:513 BROOKWOOD BLVD
Practice Address - Street 2:STE. 75
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-6862
Practice Address - Country:US
Practice Address - Phone:205-250-6805
Practice Address - Fax:205-250-6580
Is Sole Proprietor?:No
Enumeration Date:2012-11-07
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-116589363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner