Provider Demographics
NPI:1750948931
Name:BLYTHE RESKE, JOHANNA ARIEL (MD)
Entity type:Individual
Prefix:DR
First Name:JOHANNA
Middle Name:ARIEL
Last Name:BLYTHE RESKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:739 E MADISON ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-3612
Mailing Address - Country:US
Mailing Address - Phone:859-496-7426
Mailing Address - Fax:
Practice Address - Street 1:10510 LA GRANGE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-1228
Practice Address - Country:US
Practice Address - Phone:502-253-7623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-23
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3255472084P0800X
KY586312084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry