Individual
MRS. KRISTA BAIN BLAYLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
332 HIGHWAY 12 W, KOSCIUSKO, MS 39090-3209
(662) 289-1800
Mailing address
864 WILSON DR, SUITE C, RIDGELAND, MS 39157-4512
(601) 206-6100
(601) 206-6052
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R863824
MS
364SF0001X
Family Health Clinical Nurse Specialist
R863824
MS
Other
Enumeration date
11/17/2010
Last updated
08/21/2015
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