Provider Demographics
NPI:1437735552
Name:BLAIR, ROSS PARKER (APRN)
Entity type:Individual
Prefix:MR
First Name:ROSS
Middle Name:PARKER
Last Name:BLAIR
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 FISHER HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:LORETTO
Mailing Address - State:TN
Mailing Address - Zip Code:38469-3023
Mailing Address - Country:US
Mailing Address - Phone:931-242-1691
Mailing Address - Fax:
Practice Address - Street 1:203 AVALON AVE STE 230
Practice Address - Street 2:
Practice Address - City:MUSCLE SHOALS
Practice Address - State:AL
Practice Address - Zip Code:35661-2855
Practice Address - Country:US
Practice Address - Phone:256-766-8570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-19
Last Update Date:2025-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN28993363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty