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NPI Code Detail

MEDICARE: AMANDA R BLOUNT FNP-C

MEDICARE: AMANDA R BLOUNT FNP-C
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
1363LF0000XFamily Nurse Practitioner218673LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1218673OTHERLASTATE FNP LICENSE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1225701790
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA R BLOUNT FNP-C
Provider Business Mailing Address
First Line : PO BOX 122525 DEPT 2525
Second Line :
City : DALLAS
State : TX
Zip : 75312-0001
Country : US
Telephone Number : 337-494-2772
Fax Number : 337-494-2928
Provider Business Practice Location Address
First Line : 1715 WOLF CIR
Second Line :
City : LAKE CHARLES
State : LA
Zip : 70605-2353
Country : US
Telephone Number : 337-480-7499
Fax Number : 337-480-7498
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/29/2021
Last Update Date : 04/27/2022

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