Blayne O Yerby, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9110127 Issued in FL

Practice address

1419 S 6TH St
Macclenny, FL 32063-4624

Phone

(904) 653-1822

Fax

(904) 259-1225

NPI assigned

Mar 8, 2017

Last updated

Feb 12, 2021By 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 2

Addresses

Other identifiers 1

Other names 1

• Blayne O Frisbie Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Physician Assistant

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.

• Andres R Villar MD

  dba Children's Medical Center

  • Pediatrics Physician
  • Glen St Mary, FL
  • NPI 1689768772

  Single Specialty

  NPD (past)
• Andres R Villar MD

  dba Children's Medical Center

  • Pediatrics Physician
  • Macclenny, FL
  • NPI 1841384948

  Single Specialty

  NPD (past)

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

{
    "created_epoch": "1488931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613088000000",
    "number": "1497295505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "789 W DUVAL ST",
            "city": "LAKE CITY",
            "state": "FL",
            "postal_code": "320553811",
            "telephone_number": "386-755-5044",
            "fax_number": "386-755-2283"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1419 S 6TH ST",
            "city": "MACCLENNY",
            "state": "FL",
            "postal_code": "320634624",
            "telephone_number": "904-653-1822",
            "fax_number": "904-259-1225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YERBY",
        "first_name": "BLAYNE",
        "middle_name": "O",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-03-08",
        "last_updated": "2021-02-12",
        "certification_date": "2021-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "9110127",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9110127",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "020253400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BLAYNE",
            "last_name": "FRISBIE",
            "middle_name": "O",
            "credential": "PA",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Annie Clara Widemond, C.PH.T.
• Lonna Elaine Wilkes, PHARM.D.
• Willow Tree Therapy Services LLC
• Jill Woodall
• Randly Lysander Woods, MD
• Jeremie Joseph Young, MD
• Edward Bernard Zebooker, D.O.

• Physician Assistant in Macclenny, FL
• Providers in Macclenny, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.