Healthcare Provider Details

I. General information

NPI: 1003598525
Provider Name (Legal Business Name): EMILY BLACK ARNP PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2023
Last Update Date: 08/03/2023
Certification Date: 08/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 5TH ST
AMES IA
50010-6085
US

IV. Provider business mailing address

555 SW 7TH ST UNIT 8
DES MOINES IA
50309-4532
US

V. Phone/Fax

Practice location:
  • Phone: 515-233-1122
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number152689
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: