Healthcare Provider Details

I. General information

NPI: 1437324316
Provider Name (Legal Business Name): BARBARA D BLACK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2008
Last Update Date: 02/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 HOLLOWELL RD
AULANDER NC
27805-9634
US

IV. Provider business mailing address

4601 CHARLOTTE PARK DR SUITE 390
CHARLOTTE NC
28217-1915
US

V. Phone/Fax

Practice location:
  • Phone: 252-345-3791
  • Fax: 252-345-0480
Mailing address:
  • Phone: 704-529-6161
  • Fax: 704-323-7931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number17666
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5004617
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: