Provider Demographics
NPI:1548979644
Name:BLEVINS, JAXSYN RYKER
Entity type:Individual
Prefix:
First Name:JAXSYN
Middle Name:RYKER
Last Name:BLEVINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 ANN ST
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-6402
Mailing Address - Country:US
Mailing Address - Phone:304-890-0452
Mailing Address - Fax:
Practice Address - Street 1:118 ANN ST
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-6402
Practice Address - Country:US
Practice Address - Phone:304-890-0452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-16
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist