Provider Demographics
NPI:1508199860
Name:CHAMBLEE, NELLIE SUE (FNP-C)
Entity Type:Individual
Prefix:MISS
First Name:NELLIE
Middle Name:SUE
Last Name:CHAMBLEE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 CHARLES H DIMMOCK PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-2990
Mailing Address - Country:US
Mailing Address - Phone:804-520-1764
Mailing Address - Fax:804-520-1764
Practice Address - Street 1:445 CHARLES H DIMMOCK PKWY STE 100
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-2990
Practice Address - Country:US
Practice Address - Phone:804-520-1764
Practice Address - Fax:804-520-1764
Is Sole Proprietor?:No
Enumeration Date:2009-09-17
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5006518363LF0000X
VA0024168452363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1508199860Medicaid
VAVV1567AMedicare PIN
VAP00987943Medicare PIN