Provider Demographics
NPI:1417460627
Name:BLOUNT, BRENDA JOAN (PCA)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:JOAN
Last Name:BLOUNT
Suffix:
Gender:F
Credentials:PCA
Other - Prefix:MRS
Other - First Name:BRENDA
Other - Middle Name:JOAN
Other - Last Name:DAVID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:312 SWAN POND RD
Mailing Address - Street 2:
Mailing Address - City:WILEY FORD
Mailing Address - State:WV
Mailing Address - Zip Code:26767
Mailing Address - Country:US
Mailing Address - Phone:304-738-2134
Mailing Address - Fax:
Practice Address - Street 1:312 SWAN POND RD
Practice Address - Street 2:
Practice Address - City:WILEY FORD
Practice Address - State:WV
Practice Address - Zip Code:26767-8015
Practice Address - Country:US
Practice Address - Phone:304-738-2134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-09
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant