Healthcare Provider Details

I. General information

NPI: 1487285474
Provider Name (Legal Business Name): DEANDRA LATRICE CHAMBLISS AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2020
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27800 NORTHWEST FWY
CYPRESS TX
77433-5302
US

IV. Provider business mailing address

29019 CRESTED BUTTE DR
KATY TX
77494-4131
US

V. Phone/Fax

Practice location:
  • Phone: 346-231-4000
  • Fax:
Mailing address:
  • Phone: 832-613-8202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP145361
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: