| Doctor Name: | MISS TAMRIA DENISE BLACKLEY |
| NPI Number: | 1457625345 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CPNP-PC |
| License Number: | 715129 |
| Business Practice Address: | 208 Oak Dr S 400a Lake Jackson, TX - 775665790 |
| Business Phone Number: | 9792852900 |
| Business Fax Number: | 9792852904 |
| Mailing Address: | 208 Oak Dr S, 400a LAKE JACKSON |
| State: | TX |
| Postal Code: | 775665790 |
| Phone Number: | 9792852900 |
| Fax Number: | 9792852904 |
| NPI Enumeration Date: | 02/24/2012 |
| NPI Last Update Date: | 07/25/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | 715129 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |