MEDICARE: JASMINE 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	164W00000X	Licensed Practical Nurse	4703124302	MI

General Provider Information

NPI Number	:	1255072575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASMINE BLOUNT

Provider Business Mailing Address
First Line	:	1937 LAUREL OAK DR
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48507-6038
Country	:	US
Telephone Number	:	313-801-8584
Fax Number	:

Provider Business Practice Location Address
First Line	:	1937 LAUREL OAK DR
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48507-6038
Country	:	US
Telephone Number	:	313-801-8584
Fax Number	:

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

Provider Enumeration Date	:	04/02/2022
Last Update Date	:	04/02/2022

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Directions to “ JASMINE BLOUNT ” Practice Location

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