Basic Information
| Provider Information | |||||||||
| NPI: | 1225650542 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BLUE | ||||||||
| FirstName: | BRANDY | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1919 | ||||||||
| Address2: | |||||||||
| City: | OWENSBORO | ||||||||
| State: | KY | ||||||||
| PostalCode: | 423021919 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2709262273 | ||||||||
| FaxNumber: | 2706843212 | ||||||||
| Practice Location | |||||||||
| Address1: | 1030A BURLEW BLVD | ||||||||
| Address2: | |||||||||
| City: | OWENSBORO | ||||||||
| State: | KY | ||||||||
| PostalCode: | 423031735 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2709262273 | ||||||||
| FaxNumber: | 2706843212 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2020 | ||||||||
| LastUpdateDate: | 07/19/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WG0600X | 1132083 | KY | N | Nursing Service Providers | Registered Nurse | Gerontology | 363LF0000X | 3014919 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.