| Doctor Name: | KEVIN NATHANIEL BLYTHE |
| NPI Number: | 1902149123 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 7503 Surratts Rd Clinton, MD - 207353358 |
| Business Phone Number: | 2028774848 |
| Business Fax Number: | 2028772468 |
| Mailing Address: | 100 Luna Park Dr, Apt 342 ALEXANDRIA |
| State: | VA |
| Postal Code: | 223053168 |
| Phone Number: | 2487524042 |
| Fax Number: | |
| NPI Enumeration Date: | 04/05/2013 |
| NPI Last Update Date: | 06/13/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 390200000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Student, Health Care |
| Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |