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General NPI Number Information
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NPI Number | 1841691656
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Entity Type | Individual
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Provider Name | KATELYN JUNE BLOHM PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/11/2014
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Last Update Date | 07/17/2025
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Provider Practice Location Address
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Address Line | 9800 S HEALTHPARK DR STE 110
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City | FORT MYERS
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State | FL
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Zip | 33908-3630
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Country | US
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Telephone | 239-343-6202
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Fax | 239-343-4159
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Provider Business Mailing Address
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Address Line | PO BOX 2147
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City | FORT MYERS
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State | FL
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Zip | 33902-2147
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Country | US
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Telephone | 239-343-6202
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Fax | 239-343-4159
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5601007166
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9115850
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License Number State | FL
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