Provider Demographics
NPI:1356683585
Name:BLUE, KELLIE ALEXANDER (RN)
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:ALEXANDER
Last Name:BLUE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 EAGLE ROCK RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:GA
Mailing Address - Zip Code:30528-5789
Mailing Address - Country:US
Mailing Address - Phone:706-809-9822
Mailing Address - Fax:
Practice Address - Street 1:1331 HELEN HWY
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:GA
Practice Address - Zip Code:30528-2834
Practice Address - Country:US
Practice Address - Phone:706-865-2191
Practice Address - Fax:706-865-7745
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-26
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN213709163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse