Active NPI
Kyle Travis Blevins, RN
- Registered Nurse
- University Place, WA
National Provider Identifier
1114671534
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- RN61575677
- Practice address
- 6721 Regents Blvd
University Place, WA 98466-5461 - Phone
- (253) 433-7755
- NPI assigned
- Feb 4, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | RN61575677 | WA | Primary |
Addresses
Primary practice location
6721 Regents Blvd
University Place, WA 98466-5461
Mailing address
1764 Cologna Rd
Marshfield, MO 65706-9940
Phone (417) 859-6575
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN61575677 | WA | MD | Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Actriv Healthcare Inc. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Nursing Care Agency
- Vancouver, WA
- NPI 1174119978
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1643932800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1768176000000",
"number": "1114671534",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1764 COLOGNA RD",
"city": "MARSHFIELD",
"state": "MO",
"postal_code": "657069940",
"telephone_number": "417-859-6575"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6721 REGENTS BLVD",
"city": "UNIVERSITY PLACE",
"state": "WA",
"postal_code": "984665461",
"telephone_number": "253-433-7755"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLEVINS",
"first_name": "KYLE",
"middle_name": "TRAVIS",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-02-04",
"last_updated": "2026-01-12",
"certification_date": "2026-01-12",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "WA",
"license": "RN61575677",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in University Place, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.