Provider Demographics
NPI:1699197442
Name:GILLILAND, BLAIR TAYLOR (CRNP)
Entity Type:Individual
Prefix:MS
First Name:BLAIR
Middle Name:TAYLOR
Last Name:GILLILAND
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:BLAIR
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 789
Mailing Address - Street 2:44 ALIANT PARKWAY
Mailing Address - City:ALEXANDER CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35011-0789
Mailing Address - Country:US
Mailing Address - Phone:256-234-4131
Mailing Address - Fax:256-234-9979
Practice Address - Street 1:44 ALIANT PKWY
Practice Address - Street 2:
Practice Address - City:ALEXANDER CITY
Practice Address - State:AL
Practice Address - Zip Code:35010-3426
Practice Address - Country:US
Practice Address - Phone:256-234-4131
Practice Address - Fax:256-234-9979
Is Sole Proprietor?:No
Enumeration Date:2014-01-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-114364363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1-114364OtherLICENSE