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Contact Information

KRISTA B BLAYLOCK, NP
332 HIGHWAY 12 W
KOSCIUSKO, MS39090-3209
 Phone: 662-289-1800
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Nurse Practitioner

363L00000X 50 Nurse Practitioner
 

Family Health

364SF0001X 89 Certified Clinical Nurse Specialist
Indicates primary specialty

NPI Profile & details for KRISTA B BLAYLOCK · (Female)

NPI Number 1609178094
Status Active
Credentials NP (Nurse Practitioner)
Entity Individual
Enumeration date 11/17/2010
Last updated 08/21/2015 - About 11 years ago
Sole proprietor 1 No
Identifiers
  • MS License # R863824
Hospital affiliation(s)
  • MONTFORT JONES MEMORIAL HOSPITAL - (Critical Access)
    220 HWY 12 WEST
    KOSCIUSKO, MS 39090
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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