Provider Demographics
NPI:1982382198
Name:BLACKSHEAR, DAVID WAITS (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:WAITS
Last Name:BLACKSHEAR
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 MARTIN CREEK DR
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TX
Mailing Address - Zip Code:77328-5641
Mailing Address - Country:US
Mailing Address - Phone:936-283-0436
Mailing Address - Fax:
Practice Address - Street 1:8000 RESEARCH FOREST DR STE 360
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77382-1559
Practice Address - Country:US
Practice Address - Phone:281-292-1191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-07
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1127862363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily