Healthcare Provider Details

I. General information

NPI: 1508167990
Provider Name (Legal Business Name): DENISE DELYNN BLAIR RN CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DENISE DELYNN CHAMBERLAIN

II. Dates (important events)

Enumeration Date: 11/16/2010
Last Update Date: 12/29/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 11TH ST
WICHITA FALLS TX
76301-4300
US

IV. Provider business mailing address

PO BOX 9261
WICHITA FALLS TX
76308-9261
US

V. Phone/Fax

Practice location:
  • Phone: 940-764-3447
  • Fax:
Mailing address:
  • Phone: 940-764-7236
  • Fax: 940-232-8710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number255535
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: