MEDICARE: MOLLY BLACK

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	367500000X	Certified Registered Nurse Anesthetist	10041796	OR
2	367500000X	Certified Registered Nurse Anesthetist	971137	TX

General Provider Information

NPI Number	:	1114529674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOLLY BLACK

Provider Business Mailing Address
First Line	:	43 BASSETT ST
Second Line	:
City	:	FORT BRAGG
State	:	NC
Zip	:	28307-2032
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1585 3RD ST
Second Line	:
City	:	FORT POLK
State	:	LA
Zip	:	71459-5102
Country	:	US
Telephone Number	:	210-862-9692
Fax Number	:

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

Provider Enumeration Date	:	11/10/2020
Last Update Date	:	07/08/2025

Similar Medicare Providers

1366430555 — VICTOR M. CAMACHO M.D.
Practice Location Address:

1585 3RD ST
FORT POLK, LA
71459-5102

Practice Phone: 337-531-3701
Practice Fax:

1821087545 — MS. GWENDOLYN JANIS LEMAIRE NP
Practice Location Address:

1585 3RD ST
FORT POLK, LA
71459-5102

Practice Phone: 337-531-3609
Practice Fax: 337-531-3551

1356330070 — ALFONSO SANTOS ALARCON M.D.
Practice Location Address:

1585 3RD ST , BOX 81
FORT POLK, LA
71459-5102

Practice Phone: 337-531-3105
Practice Fax:

1497745327 — GERALDINE STUMP EARWOOD CRNP
Practice Location Address:

1585 3RD ST , INTERNAL MEDICINE CLINIC
FORT POLK, LA
71459-5102

Practice Phone: 337-531-3723
Practice Fax: 337-531-3100

1730179276 — DR. MOHAMMAD FARRUKH KHAN MD
Practice Location Address:

1585 3RD ST
FORT POLK, LA
71459-5102

Practice Phone: 337-653-2373
Practice Fax:

1871572669 — JEFFREY DOUGLAS GROW M.D.
Practice Location Address:

1585 3RD ST
FORT POLK, LA
71459-5102

Practice Phone: 207-530-6514
Practice Fax:

1669442349 — DR. MICHAEL DRINKHAUS DAVIS M.D.
Practice Location Address:

1585 3RD ST , BAYNE-JONES ARMY COMMUNITY HOSPITAL
FORT POLK, LA
71459-5102

Practice Phone: 337-531-3527
Practice Fax: 337-531-3184

Directions to “ MOLLY BLACK ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.