MEDICARE: MRS. KIMBERLY LAJUAN BLACK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	172A00000X	Driver
2	3747A0650X	Attendant Care Provider
3	3747P1801X	Personal Care Attendant
4	374U00000X	Home Health Aide	OH
5	376J00000X	Homemaker
6	372600000X	Adult Companion	OH

General Provider Information

NPI Number	:	1710836796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIMBERLY LAJUAN BLACK

Provider Business Mailing Address
First Line	:	1060 BARBERRY LN
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43213-3310
Country	:	US
Telephone Number	:	614-348-8111
Fax Number	:	614-474-8623

Provider Business Practice Location Address
First Line	:	1060 BARBERRY LN
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43213-3310
Country	:	US
Telephone Number	:	614-348-8111
Fax Number	:	614-474-8623

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

Provider Enumeration Date	:	01/23/2026
Last Update Date	:	01/23/2026

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