Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Blaise Fondren

Individual provider Registered Nurse · NPI 1679341630

Blaise Fondren is a Nurse Practitioner in Oxford, Mississippi. Qualified in 2024, 2 years ago. Practices with Yalobusha General Hospital, a 20-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Mississippi and Tennessee.

Years since qualifying
2
Licensed in
MS, TN
In the registry since
2023
Specialties on file
3
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Practice location Address checks out

2222 Jackson Ave W
Oxford, MS 38655-5409
Phone: (662) 380-5560
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 420 N Main St, Water Valley, MS 38965-2506 — (662) 473-5273

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence 906484 (MS)
Registered Nurse Taxonomy 163W00000X · Licence 899036 (MS)
Family Nurse Practitioner Taxonomy 363LF0000X · Licence 36596 (TN)

Record details

NPI number1679341630
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedDecember 19, 2023
Last updated in NPPESJuly 28, 2025
Certification dateJuly 28, 2025
Mailing address420 Live Oak Dr, Oxford, MS 38655-2962

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Group practice Yalobusha General Hospital — 20 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations8 on file with Medicare

Other providers in Oxford