Individual
STUART TRAVIS BLEVINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
899 E BROAD ST, COLUMBUS, OH 43205-1156
(614) 928-9400
(614) 928-9401
Mailing address
3095 KETTERING BLVD, MORAINE, OH 45439-1983
(614) 928-9400
(614) 928-9401
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
RN280389-COA1
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0094077
—
OH
01
—
20679468060
CARESOURCE
—
Enumeration date
03/13/2013
Last updated
05/25/2017
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