Healthcare Provider Details

I. General information

NPI: 1235920281
Provider Name (Legal Business Name): SOPHIA BLOUNT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2025
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5306 NC HIGHWAY 55 STE 105
DURHAM NC
27713-7812
US

IV. Provider business mailing address

5306 NC HIGHWAY 55 STE 105
DURHAM NC
27713-7812
US

V. Phone/Fax

Practice location:
  • Phone: 877-279-5960
  • Fax: 919-390-0018
Mailing address:
  • Phone: 877-279-5960
  • Fax: 919-390-0018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number5022320
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: