Provider Demographics
NPI:1255941308
Name:BLOSSER, JOANN KAY (RN)
Entity type:Individual
Prefix:
First Name:JOANN
Middle Name:KAY
Last Name:BLOSSER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13591 COUNTY ROAD 420
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75704-2215
Mailing Address - Country:US
Mailing Address - Phone:903-521-5012
Mailing Address - Fax:
Practice Address - Street 1:13591 COUNTY ROAD 420
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75704-2215
Practice Address - Country:US
Practice Address - Phone:903-521-5012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-04
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX667841163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse