Individual
JACOB BENJAMIN BLOUNT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSN, APRN, FNP-C
Contact information
Practice address
1224 REYNOLDS DR, CHARLESTON, IL 61920-2436
(217) 317-9469
Mailing address
1224 REYNOLDS DR, CHARLESTON, IL 61920-2436
(217) 317-9469
Taxonomy
Speciality
Code
Description
License number
State
163WE0003X
Emergency Registered Nurse
041.421877
IL
363LF0000X
Family Nurse Practitioner
Primary
209.018171
IL
Other
Enumeration date
02/08/2019
Last updated
07/11/2020
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