Individual
JORDAN BLYTHE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
451 PHILLIPS ST, WEST FORK, AR 72774-2813
(479) 294-6085
Mailing address
4196 HIGHWAY 62 412 STE A, HARDY, AR 72542-8002
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
12/21/2022
Last updated
04/10/2025
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