Provider Demographics
NPI:1457781296
Name:BLAIR, CHYNNA SUE (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:CHYNNA
Middle Name:SUE
Last Name:BLAIR
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 1:2511 KILDEER CT
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-4861
Mailing Address - Country:US
Mailing Address - Phone:254-974-3033
Mailing Address - Fax:
Practice Address - Street 1:2600 FM 1764 RD
Practice Address - Street 2:SUITE 190
Practice Address - City:LA MARQUE
Practice Address - State:TX
Practice Address - Zip Code:77568-2824
Practice Address - Country:US
Practice Address - Phone:281-886-8964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-14
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX737378363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily