Christine H Blair, PNP-PC, RN

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

17077 Issued in TN

Practice address

1102 Brookfield Road
Suite 200
Memphis, TN 38119

Phone

(901) 761-1880

Fax

(901) 683-2048

NPI assigned

Oct 18, 2012

Last updated

Aug 12, 2014By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Registered Nurse

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Pediatric and Adolescent Medicine

  • Pediatrics Physician
  • Memphis, TN
  • NPI 1235350786
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1350518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1407801600000",
    "number": "1235482928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 RIVERWALK PL",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381030847",
            "telephone_number": "865-356-2017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1102 BROOKFIELD ROAD",
            "address_2": "SUITE 200",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "38119",
            "telephone_number": "901-761-1880",
            "fax_number": "901-683-2048"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAIR",
        "first_name": "CHRISTINE",
        "middle_name": "H",
        "name_prefix": "Mrs.",
        "credential": "PNP-PC, RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-10-18",
        "last_updated": "2014-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "TN",
            "license": "17077",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Victoria Elise Blackmon
• Yolanda Ravon Blackmon, RN
• Amber Blackshear, LCSW
• Taneshia Blackshire
• Shanna Nichole Blackwell, FNP-C
• Robert Neal Blair, D.D.S.
• Karole Denise Blake-Shorter, LCSW
• Claire Blake, CGC
• Jasmine Blake
• Lindsey Blake

• Pediatric Nurse Practitioner in Memphis, TN
• Providers in Memphis, TN by specialty
• Pediatric Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.