Healthcare Provider Details

I. General information

NPI: 1740994482
Provider Name (Legal Business Name): JASMINE BLUNT DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2023
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 E BROADWAY AVE STE 25
JACKSON WY
83001-8632
US

IV. Provider business mailing address

140 E BROADWAY AVE STE 25
JACKSON WY
83001-8632
US

V. Phone/Fax

Practice location:
  • Phone: 443-834-1058
  • Fax: 307-333-0410
Mailing address:
  • Phone:
  • Fax: 307-333-0410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR239297
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR239297
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: