Basic Information
| Provider Information | |||||||||
| NPI: | 1336786383 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BLYTHE | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | LEVI | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1326 PAPERMILL POINTE WAY | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379091903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8652432136 | ||||||||
| FaxNumber: | 8652432138 | ||||||||
| Practice Location | |||||||||
| Address1: | 2103 FOREST DR STE 5 | ||||||||
| Address2: | |||||||||
| City: | GRAY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376158423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4237943142 | ||||||||
| FaxNumber: | 4237943184 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/09/2019 | ||||||||
| LastUpdateDate: | 05/10/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363AS0400X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
ID Information
| ID | Type | State | Issuer | Description | 3961 | 01 | TN | MEDICAL LICENSE | OTHER |