Healthcare Provider Details

I. General information

NPI: 1467188748
Provider Name (Legal Business Name): TONIA BLOUNT PRSS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2022
Last Update Date: 07/28/2022
Certification Date: 07/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 WASHINGTON ST W
CHARLESTON WV
25302-1333
US

IV. Provider business mailing address

1303 WASHINGTON ST W
CHARLESTON WV
25302-1333
US

V. Phone/Fax

Practice location:
  • Phone: 304-202-1699
  • Fax: 304-699-2141
Mailing address:
  • Phone: 304-202-1699
  • Fax: 304-699-2141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: