MEDICARE: MRS. TRESSA LUCAS BLYTHE PMHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	0024194774	VA

General Provider Information

NPI Number	:	1497645170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TRESSA LUCAS BLYTHE PMHNP

Provider Business Mailing Address
First Line	:	1311 ROMAN DR
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-7718
Country	:	US
Telephone Number	:	757-319-7285
Fax Number	:

Provider Business Practice Location Address
First Line	:	1311 ROMAN DR
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-7718
Country	:	US
Telephone Number	:	757-319-7285
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2025
Last Update Date	:	09/24/2025

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