Provider Demographics
NPI:1841867967
Name:BLAZEY, ELIZABETH BLAIR (NP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:BLAIR
Last Name:BLAZEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:BLAIR
Other - Last Name:HALSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8442 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40258-1140
Mailing Address - Country:US
Mailing Address - Phone:502-638-4280
Mailing Address - Fax:502-638-4281
Practice Address - Street 1:800 N HIGH ST STE 4-102
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-1430
Practice Address - Country:US
Practice Address - Phone:614-636-5017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3016382363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1132681OtherLICENSE