Provider Demographics
NPI:1871831214
Name:BLAIR, AUDRA KAY (BHCM II)
Entity Type:Individual
Prefix:
First Name:AUDRA
Middle Name:KAY
Last Name:BLAIR
Suffix:
Gender:F
Credentials:BHCM II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7824 NW 83RD ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73132-3305
Mailing Address - Country:US
Mailing Address - Phone:405-830-5732
Mailing Address - Fax:405-726-8967
Practice Address - Street 1:7824 NW 83RD ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73132-3305
Practice Address - Country:US
Practice Address - Phone:405-830-5732
Practice Address - Fax:405-367-7635
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-18
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200475600 AMedicaid