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Individual
MR. KYLE MATTHEW BLEVINGS
Active
Individual
MR. KYLE MATTHEW BLEVINGS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LAT, ATC
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
OH
2255A2300X
Athletic Trainer
2000015073
—
2255A2300X
Athletic Trainer
AT 0000001766
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2000015073
BOARD OF CERTIFICATION (BOC)
—
01
—
AT 0000001766
STATE OF TENNESSEE DIVISION OF HEALTH RELATED BOARDS
TN
Enumeration date
07/07/2016
Last updated
10/01/2020
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