Provider Demographics
NPI:1124917943
Name:BLALOCK, AMBER (FNP)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:BLALOCK
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 1:2250 WHITE HOUSE CV
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-8819
Mailing Address - Country:US
Mailing Address - Phone:757-510-5036
Mailing Address - Fax:
Practice Address - Street 1:2250 WHITE HOUSE CV
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-8819
Practice Address - Country:US
Practice Address - Phone:757-510-5036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-30
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001316473163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency