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Candice Laura Blair

Nurse Practitioner

Physician Assistants & Advanced Practice Nursing Providers

1915 White Ave, Knoxville, TN 37916-2300

PECOS Enrollment

This provider is enrolled in PECOS as CANDICE BLAIR.

Based on the most recent information from CMS, provider Candice Laura Blair is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 3 days ago.

Profile Details

Provider ID
1811594146
Provider Type
Individual
Full Name
Blair, Candice Laura
Credential
NP

Gender
Female
Sole Proprietor
No
Enumeration Date
10/9/2020
Last Updated
10/14/2020

Contact Information

Practice Location

1915 White Ave, Knoxville, TN 37916-2300

(865) 331-1720

Unlisted Fax

Mailing Location

1915 White Ave, Knoxville, TN 37916-2300

Unlisted Phone

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363LF0000X Primary	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License 27497 Tennessee

Provider Identifiers

ID	Description	Issuer
ID Q061035	Description Medicaid	Issuer Unlisted Tennessee

Candice Laura Blair

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

Irwin, James Tyler

Wallace, Elizabeth Ann

Harvey, Sarah A

Salem, Randa Khalid

Brumbach, Jennifer L

Taylor, Erik

O'Hare, Esther Marie

Art, Olivia Caroline

White, Catherine

Stevens, Jenny R