| Doctor Name: | LEISA JAN BLUE |
| NPI Number: | 1851342950 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CFNP |
| License Number: | 089876 |
| Business Practice Address: | 55 Nesbit Dr Bonne Terre, MO - 636281353 |
| Business Phone Number: | 5733581480 |
| Business Fax Number: | |
| Mailing Address: | 7100 Commerce Way, Suite 180 BRENTWOOD |
| State: | TN |
| Postal Code: | 370272829 |
| Phone Number: | 6154657000 |
| Fax Number: | |
| NPI Enumeration Date: | 05/13/2006 |
| NPI Last Update Date: | 11/26/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 089876 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |