| Doctor Name: | MRS. KRISTA BAIN BLAYLOCK |
| NPI Number: | 1609178094 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | N.P. |
| License Number: | R863824 |
| Business Practice Address: | 332 Highway 12 W Kosciusko, MS - 390903209 |
| Business Phone Number: | 6622891800 |
| Business Fax Number: | |
| Mailing Address: | 864 Wilson Dr, Suite C RIDGELAND |
| State: | MS |
| Postal Code: | 391574512 |
| Phone Number: | 6012066100 |
| Fax Number: | 6012066052 |
| NPI Enumeration Date: | 11/17/2010 |
| NPI Last Update Date: | 08/21/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 364SF0001X |
| License Number: | R863824 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MS |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Clinical Nurse Specialist |
| Taxonomy Specialization: | Family Health |
| Taxonomy Definition: | |