Provider Demographics
NPI:1841254018
Name:BLEVINS, AMY REED (LNP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:REED
Last Name:BLEVINS
Suffix:
Gender:F
Credentials:LNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 W RIDGE RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:WYTHEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24382-1046
Mailing Address - Country:US
Mailing Address - Phone:276-223-3329
Mailing Address - Fax:276-223-0478
Practice Address - Street 1:770 W RIDGE RD
Practice Address - Street 2:SUITE 220
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382-1046
Practice Address - Country:US
Practice Address - Phone:276-223-3329
Practice Address - Fax:276-223-0478
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024165275363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00017719OtherMEDICARE RAILROAD
VAC04810OtherMEDICARE GROUP
VA004945298Medicaid
VA01451713OtherAMERGROUP
P00017719OtherMEDICARE RAILROAD
P65912Medicare UPIN