MEDICARE: DR. KATINA M BLUE PHD

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	3747P1801X	Personal Care Attendant	NC
2	3747P1801X	Personal Care Attendant
3	376K00000X	Nurse's Aide	NC

General Provider Information

NPI Number	:	1790515518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATINA M BLUE PHD

Provider Business Mailing Address
First Line	:	264 MERIDIAN DR
Second Line	:
City	:	GARNER
State	:	NC
Zip	:	27529-6899
Country	:	US
Telephone Number	:	919-696-1296
Fax Number	:	919-661-8195

Provider Business Practice Location Address
First Line	:	101 N MARKET ST
Second Line	:
City	:	BENSON
State	:	NC
Zip	:	27504-1514
Country	:	US
Telephone Number	:	919-404-9006
Fax Number	:	919-661-8195

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

Provider Enumeration Date	:	08/06/2024
Last Update Date	:	08/06/2024

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