Healthcare Provider Details

I. General information

NPI: 1215202320
Provider Name (Legal Business Name): CHANDRA B. BLANKEN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2012
Last Update Date: 10/02/2021
Certification Date: 10/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1066 RUTLEDGE PIKE
BLAINE TN
37709-3027
US

IV. Provider business mailing address

620 BLOUNT CIR
RUTLEDGE TN
37861-5698
US

V. Phone/Fax

Practice location:
  • Phone: 865-933-9477
  • Fax: 865-933-9466
Mailing address:
  • Phone: 865-850-4168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0000016569
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: