Provider Demographics
NPI:1700469590
Name:BLAIR, TIERRA J
Entity Type:Individual
Prefix:
First Name:TIERRA
Middle Name:J
Last Name:BLAIR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2540 CARTERS RUN RD
Mailing Address - Street 2:
Mailing Address - City:PIKETON
Mailing Address - State:OH
Mailing Address - Zip Code:45661-9624
Mailing Address - Country:US
Mailing Address - Phone:740-804-2286
Mailing Address - Fax:
Practice Address - Street 1:923 SEDAN CRABTREE RD UNIT C
Practice Address - Street 2:
Practice Address - City:LUCASVILLE
Practice Address - State:OH
Practice Address - Zip Code:45648-9314
Practice Address - Country:US
Practice Address - Phone:740-259-8434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-30
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide