MEDICARE: KELLI BLUNT

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1316742851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLI BLUNT

Provider Business Mailing Address
First Line	:	2102 5TH ST N STE 3
Second Line	:
City	:	COLUMBUS
State	:	MS
Zip	:	39705-2222
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2102 5TH ST N STE 3
Second Line	:
City	:	COLUMBUS
State	:	MS
Zip	:	39705-2222
Country	:	US
Telephone Number	:	662-889-6639
Fax Number	:

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

Provider Enumeration Date	:	02/18/2025
Last Update Date	:	02/18/2025

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Directions to “ KELLI BLUNT ” Practice Location

Language	Start Address	Practice Location

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