NPI 1891711131 · live from the CMS NPI Registry
Kelly Lane Blair, Ph.D
Psychologist, Clinical in Jackson, TN. National Provider Identifier 1891711131, active.
NPI record
| NPI | 1891711131 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Psychologist, Clinical 103TC0700X |
| Practice location | 708 W Forest Ave, Jackson, TN 38301 |
| Practice phone | 731-425-4930 |
| Mailing address | 1804 Highway 45 Byp, Suite 604, Jackson, TN 38305 |
| Enumerated | July 13, 2006 |
| Last updated | July 31, 2009 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Psychologist, Clinical primary | 103TC0700X | 1706 (TN) |
| Psychologist, Rehabilitation | 103TR0400X | 1706 (TN) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.