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Individual

STACEY BLYTH

Active
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Individual

STACEY BLYTH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
200401473
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1366706
CIGNA
NC
01
—
138H7
BCBS
NC
01
—
2478977
UNITED HEALTHCARE
NC
05
—
89138H7
—
NC
01
—
A19578
PRO-NET
NC
01
—
D8827
MEDCOST
NC
01
—
P00222461
RAILROAD MEDICARE
NC
Enumeration date
01/20/2006
Last updated
08/11/2021
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