MEDICARE: PEYTON BLOUNT

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1134833403
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PEYTON BLOUNT

Provider Business Mailing Address
First Line	:	30 W RAMPART ST STE 230
Second Line	:
City	:	SHELBYVILLE
State	:	IN
Zip	:	46176-8897
Country	:	US
Telephone Number	:	317-398-7644
Fax Number	:	317-401-2214

Provider Business Practice Location Address
First Line	:	30 W RAMPART ST STE 230
Second Line	:
City	:	SHELBYVILLE
State	:	IN
Zip	:	46176-8897
Country	:	US
Telephone Number	:	317-398-7644
Fax Number	:	317-401-2214

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

Provider Enumeration Date	:	01/10/2023
Last Update Date	:	06/04/2026

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Directions to “ PEYTON BLOUNT ” Practice Location

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