MEDICARE: MRS. HEATHER BLACK FNP-BC, PMHNP

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	363LP2300X	Primary Care Nurse Practitioner	5013805	NC
2	363L00000X	Nurse Practitioner	5013805	NC
3	363LF0000X	Family Nurse Practitioner	5013805	NC
4	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	5013805	NC

General Provider Information

NPI Number	:	1447850458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HEATHER BLACK FNP-BC, PMHNP

Provider Business Mailing Address
First Line	:	1121 SWEETSHRUB CT
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28409-7600
Country	:	US
Telephone Number	:	910-232-0140
Fax Number	:

Provider Business Practice Location Address
First Line	:	720 N 3RD ST STE 401
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28401-3474
Country	:	US
Telephone Number	:	910-769-9126
Fax Number	:

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

Provider Enumeration Date	:	10/28/2020
Last Update Date	:	03/04/2026

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