Provider Demographics
NPI:1922029131
Name:CHAMBLEY, BLENDA H (FNP)
Entity Type:Individual
Prefix:
First Name:BLENDA
Middle Name:H
Last Name:CHAMBLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 SUNSET DR
Mailing Address - Street 2:SUITE Q
Mailing Address - City:GRENADA
Mailing Address - State:MS
Mailing Address - Zip Code:38901-4086
Mailing Address - Country:US
Mailing Address - Phone:662-294-9101
Mailing Address - Fax:662-294-9104
Practice Address - Street 1:1300 SUNSET DR
Practice Address - Street 2:SUITE Q
Practice Address - City:GRENADA
Practice Address - State:MS
Practice Address - Zip Code:38901-4086
Practice Address - Country:US
Practice Address - Phone:662-294-9101
Practice Address - Fax:662-294-9104
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR505552363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00705241Medicaid
TN3341228Medicaid
MS00705241Medicaid
MS500002216Medicare PIN
MS00705241Medicaid