Healthcare Provider Details

I. General information

NPI: 1366422602
Provider Name (Legal Business Name): BRYAN BLYTHE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16410 SMOKEY POINT BLVD STE 101
ARLINGTON WA
98223-8415
US

IV. Provider business mailing address

1 BOONE RD
BREMERTON WA
98312-1894
US

V. Phone/Fax

Practice location:
  • Phone: 877-522-1275
  • Fax:
Mailing address:
  • Phone: 360-475-4426
  • Fax: 360-475-4344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA10003484
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: