Provider Demographics
NPI:1336786383
Name:BLYTHE, ANDREW LEVI (PA-C)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:LEVI
Last Name:BLYTHE
Suffix:
Gender:M
Credentials:PA-C
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1326 PAPERMILL POINTE WAY
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-1903
Mailing Address - Country:US
Mailing Address - Phone:865-243-2136
Mailing Address - Fax:865-243-2138
Practice Address - Street 1:2103 FOREST DR STE 5
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:TN
Practice Address - Zip Code:37615-8423
Practice Address - Country:US
Practice Address - Phone:423-794-3142
Practice Address - Fax:423-794-3184
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-09
Last Update Date:2024-05-13
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3961OtherMEDICAL LICENSE