Healthcare Provider Details

I. General information

NPI: 1427730506
Provider Name (Legal Business Name): MS. KIRSTIE BLACK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2023
Last Update Date: 08/07/2023
Certification Date: 08/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11212 ALBION ALY
SPRINGDALE OH
45246-3782
US

IV. Provider business mailing address

11212 ALBION ALY
SPRINGDALE OH
45246-3782
US

V. Phone/Fax

Practice location:
  • Phone: 513-620-3963
  • Fax:
Mailing address:
  • Phone: 513-620-3963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License NumberRN.436101
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License NumberRN.436101
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberRN.436101
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateNULL
# 5
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.436101
License Number StateOH
# 6
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN.436101
License Number StateOH
# 7
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberRN.436101
License Number StateOH
# 8
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberRN.436101
License Number StateOH
# 9
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberRN.436101
License Number StateOH
# 10
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License NumberRN.436101
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: