Provider Demographics
NPI:1700862091
Name:BLOUNT, PAULA (PA)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:BLOUNT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:
Other - Last Name:YANERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3200 MACCORKLE AVENUE SE
Mailing Address - Street 2:EMERGENCY DEPARTMENT
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304
Mailing Address - Country:US
Mailing Address - Phone:304-388-4172
Mailing Address - Fax:304-388-4155
Practice Address - Street 1:3200 MACCORKLE AVE SE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1227
Practice Address - Country:US
Practice Address - Phone:304-388-4170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV00521363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001718072OtherWV BCBS
WV1069532OtherWV DWC
WVP52096Medicare UPIN
WV001718072OtherWV BCBS
WV18674Medicare PIN
WV1069532OtherWV DWC
WVP00003463Medicare PIN
WVP00003468Medicare PIN
WV18672Medicare PIN