Healthcare Provider Details

I. General information

NPI: 1134833403
Provider Name (Legal Business Name): PEYTON BLOUNT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2023
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 W RAMPART ST STE 230
SHELBYVILLE IN
46176-8897
US

IV. Provider business mailing address

30 W RAMPART ST STE 230
SHELBYVILLE IN
46176-8897
US

V. Phone/Fax

Practice location:
  • Phone: 317-398-7644
  • Fax: 317-401-2214
Mailing address:
  • Phone: 317-398-7644
  • Fax: 317-401-2214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: