Provider Demographics
NPI:1215202320
Name:BLANKEN, CHANDRA B (APRN)
Entity Type:Individual
Prefix:MRS
First Name:CHANDRA
Middle Name:B
Last Name:BLANKEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 BLOUNT CIR
Mailing Address - Street 2:
Mailing Address - City:RUTLEDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37861-5698
Mailing Address - Country:US
Mailing Address - Phone:865-850-4168
Mailing Address - Fax:
Practice Address - Street 1:1066 RUTLEDGE PIKE
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:TN
Practice Address - Zip Code:37709-3027
Practice Address - Country:US
Practice Address - Phone:865-933-9477
Practice Address - Fax:865-933-9466
Is Sole Proprietor?:No
Enumeration Date:2012-03-22
Last Update Date:2021-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000016569363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily