Provider Demographics
NPI:1013461763
Name:BLYTH, CATHERINE (FNP-BC)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:BLYTH
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 REID PKWY
Mailing Address - Street 2:MEDICAL STAFF SERVICES
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1157
Mailing Address - Country:US
Mailing Address - Phone:765-935-8594
Mailing Address - Fax:765-935-8595
Practice Address - Street 1:1250 CHESTER BLVD.
Practice Address - Street 2:SUITE 1
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1944
Practice Address - Country:US
Practice Address - Phone:765-935-8594
Practice Address - Fax:765-935-8595
Is Sole Proprietor?:No
Enumeration Date:2016-08-11
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.019394363LF0000X
IN71006855A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0205837Medicaid
IN300000316Medicaid
000001071340OtherANTHEM
INPENDINGMedicaid