Provider Demographics
NPI:1659964682
Name:BLOUNT, AUDREY (CNP)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:BLOUNT
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 S LEXINGTON SPRINGMILL RD
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OH
Mailing Address - Zip Code:44906-1327
Mailing Address - Country:US
Mailing Address - Phone:740-358-6551
Mailing Address - Fax:
Practice Address - Street 1:1065 DELAWARE AVE STE A
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-6461
Practice Address - Country:US
Practice Address - Phone:740-387-7246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-20
Last Update Date:2021-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.021527363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily