Healthcare Provider Details

I. General information

NPI: 1528360039
Provider Name (Legal Business Name): TRACY B CHAMBLEE PHD. APRN,
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2010
Last Update Date: 04/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1935 MEDICAL DISTRICT DR
DALLAS TX
75235-7701
US

IV. Provider business mailing address

1935 MEDICAL DISTRICT DR
DALLAS TX
75235-7701
US

V. Phone/Fax

Practice location:
  • Phone: 214-456-7495
  • Fax: 214-456-7492
Mailing address:
  • Phone: 214-456-7495
  • Fax: 214-456-7492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0200X
TaxonomyPediatric Clinical Nurse Specialist
License Number135773
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: