Provider Demographics
NPI:1821248717
Name:BLAIR, MELISSA RENEA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:RENEA
Last Name:BLAIR
Suffix:
Gender:F
Credentials:FNP-BC
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 34099
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37930-4099
Mailing Address - Country:US
Mailing Address - Phone:865-392-6060
Mailing Address - Fax:865-392-6061
Practice Address - Street 1:707 DOLLY PARTON PKWY
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-3961
Practice Address - Country:US
Practice Address - Phone:865-453-6011
Practice Address - Fax:865-453-9839
Is Sole Proprietor?:No
Enumeration Date:2008-09-26
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13636363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily