Provider Demographics
NPI:1083315972
Name:BLOUNT, MONTRESSA MONIQUE (NP)
Entity Type:Individual
Prefix:MS
First Name:MONTRESSA
Middle Name:MONIQUE
Last Name:BLOUNT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 77
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-0077
Mailing Address - Country:US
Mailing Address - Phone:252-341-1638
Mailing Address - Fax:
Practice Address - Street 1:3612 POWHATAN RD
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27527-9217
Practice Address - Country:US
Practice Address - Phone:919-550-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5017793363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner