NPI
Jack Colt Blaine
NPI 1811999642
Read from the NPPES registry on October 23, 2026.
Facts
- Status
- Active
- Credential
- CRNA
- Type
- Individual
- Enumeration date
- 2005-08-11
- Last updated
- 2022-01-19
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Specialties
Licenses
- License AZ
- CRNA0061
- License TX
- AP108435
- License CA
- NA1771
- License NM
- CRNA00868
Location
- Practice location
- 6709 Academy Rd NE Ste A
- City
- Albuquerque NM
- Postal code
- 87109-3363
- Phone
- (505) 312-4712
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
No exclusion found for this NPI in the OIG LEIE file dated October 9, 2026. Confirm on OIG's online search.
Nearby
Other NPIs in Albuquerque, NM. 29,199 records in the public file.
Public data from NPPES and CMS. Not a credentialing determination.
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