MEDICARE: MICHON BLOWE PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	0024189247	VA
2	163W00000X	Registered Nurse	0001209359	VA

General Provider Information

NPI Number	:	1083091656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHON BLOWE PMHNP-BC

Provider Business Mailing Address
First Line	:	4830 W HUNDRED RD
Second Line	:
City	:	CHESTER
State	:	VA
Zip	:	23831-1775
Country	:	US
Telephone Number	:	804-606-0272
Fax Number	:	804-256-3527

Provider Business Practice Location Address
First Line	:	4830 W HUNDRED RD
Second Line	:
City	:	CHESTER
State	:	VA
Zip	:	23831-1775
Country	:	US
Telephone Number	:	176-021-0223
Fax Number	:	804-256-3527

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2015
Last Update Date	:	03/05/2026

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