Provider Demographics
NPI:1265884910
Name:BLOUNT, DAVID BRANDON (APRN)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:BRANDON
Last Name:BLOUNT
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 E 9TH ST
Mailing Address - Street 2:
Mailing Address - City:RECTOR
Mailing Address - State:AR
Mailing Address - Zip Code:72461-2705
Mailing Address - Country:US
Mailing Address - Phone:870-595-3596
Mailing Address - Fax:
Practice Address - Street 1:715 E 9TH ST
Practice Address - Street 2:
Practice Address - City:RECTOR
Practice Address - State:AR
Practice Address - Zip Code:72461-2705
Practice Address - Country:US
Practice Address - Phone:870-595-3596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-06
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004811363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily