Provider Demographics
NPI:1518398825
Name:BLALOCK, CHASITY H (FNP-C)
Entity Type:Individual
Prefix:
First Name:CHASITY
Middle Name:H
Last Name:BLALOCK
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 1:28 WHITE BRIDGE RD STE 209
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-1466
Mailing Address - Country:US
Mailing Address - Phone:615-352-3000
Mailing Address - Fax:615-352-6673
Practice Address - Street 1:28 WHITE BRIDGE RD STE 209
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-1466
Practice Address - Country:US
Practice Address - Phone:615-352-3000
Practice Address - Fax:615-352-6673
Is Sole Proprietor?:No
Enumeration Date:2013-12-12
Last Update Date:2014-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18018363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ002951Medicaid
TN10350I5418Medicare PIN