Provider Demographics
NPI:1689326092
Name:BLAIR, CASEY BEECHAM (FNP)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:BEECHAM
Last Name:BLAIR
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10777 HIGHWAY 412 W
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38351-6283
Mailing Address - Country:US
Mailing Address - Phone:731-968-5558
Mailing Address - Fax:731-968-5567
Practice Address - Street 1:10777 HIGHWAY 412 W
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:TN
Practice Address - Zip Code:38351-6283
Practice Address - Country:US
Practice Address - Phone:731-968-5558
Practice Address - Fax:731-968-5567
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-26
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN31128207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine