Provider Demographics
NPI:1912246331
Name:BLAKE, KATHERINE E (NP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:E
Last Name:BLAKE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 S GLENBURNIE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-5229
Mailing Address - Country:US
Mailing Address - Phone:252-631-5188
Mailing Address - Fax:815-729-1643
Practice Address - Street 1:2002 S GLENBURNIE RD STE 100
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-5229
Practice Address - Country:US
Practice Address - Phone:252-631-5188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-05
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209009946363LF0000X, 363LP2300X
NC5019185363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care