MEDICARE: MS. MONTRESSA MONIQUE BLOUNT NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	GAA-NP002272	GA
2	363LG0600X	Gerontology Nurse Practitioner	5017793	NC
3	363L00000X	Nurse Practitioner	APRN.CNP.0036326	OH
4	363L00000X	Nurse Practitioner	4704442287	MI
5	363L00000X	Nurse Practitioner	5017793	NC
6	363L00000X	Nurse Practitioner	14275523-4405	UT

General Provider Information

NPI Number	:	1083315972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MONTRESSA MONIQUE BLOUNT NP

Provider Business Mailing Address
First Line	:	PO BOX 77
Second Line	:
City	:	WINTERVILLE
State	:	NC
Zip	:	28590-0077
Country	:	US
Telephone Number	:	252-341-1638
Fax Number	:

Provider Business Practice Location Address
First Line	:	3612 POWHATAN RD
Second Line	:
City	:	CLAYTON
State	:	NC
Zip	:	27527-9217
Country	:	US
Telephone Number	:	919-550-2200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2023
Last Update Date	:	05/11/2026

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