MEDICARE: KATHERINE E BLAKE N.P.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	209009946	IL
2	363LP2300X	Primary Care Nurse Practitioner	209009946	IL
3	363LF0000X	Family Nurse Practitioner	5019185	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912246331
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE E BLAKE N.P.

Provider Business Mailing Address
First Line	:	2002 S GLENBURNIE RD STE 100
Second Line	:
City	:	NEW BERN
State	:	NC
Zip	:	28562-5229
Country	:	US
Telephone Number	:	252-631-5188
Fax Number	:	815-729-1643

Provider Business Practice Location Address
First Line	:	2002 S GLENBURNIE RD STE 100
Second Line	:
City	:	NEW BERN
State	:	NC
Zip	:	28562-5229
Country	:	US
Telephone Number	:	252-631-5188
Fax Number	:

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

Provider Enumeration Date	:	02/05/2013
Last Update Date	:	03/12/2024

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Directions to “ KATHERINE E BLAKE N.P.” Practice Location

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