Most Relevant Information
Provider Data
| NPI Number: | 1003261363 |
| Provider Name: | TIERRA ELONDA BLACKMON |
| Entity Type: | Individual |
| Taxonomy Code: | 363L00000X |
| Specialty: | Nurse Practitioner |
| License Number: | 901816 |
Most Important Dates
| Enumeration Date: | 04/24/2016 |
| Last Updated: | 11/13/2019 |
Provider Practice Location
5323 HARRY HINES BLVD
DALLAS
TX
753907208
Practice Location Phone/Fax
| Phone: | 2146335555 |
| Fax: |
Provider Mailing Location
PO BOX 845347
DALLAS
TX
752487208
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |