JACOB BENJAMIN BLOUNT Advanced Practice Nurse License verification

Business Entity

ACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****64

License Status

ACTIVE

Business

First Name

JACOB

Middle

BENJAMIN

Last Name

BLOUNT

Business Name

JACOB BENJAMIN BLOUNT

Original Issue Date

11/18/2023

Effective Date

03/02/2026

Expiration Date

05/31/2028

City

BARTONVILLE

State

Zip

61607

County

PEORIA

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/02/2026