Provider Demographics
NPI:1699062687
Name:BLYTHE, TIFFANNY PITTS (DO)
Entity type:Individual
Prefix:
First Name:TIFFANNY
Middle Name:PITTS
Last Name:BLYTHE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1026 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:64067-1345
Mailing Address - Country:US
Mailing Address - Phone:660-259-2216
Mailing Address - Fax:
Practice Address - Street 1:1026 MAIN ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MO
Practice Address - Zip Code:64067-1345
Practice Address - Country:US
Practice Address - Phone:660-259-2216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014012501207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine