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General NPI Number Information
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NPI Number | 1326400185
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Entity Type | Organization
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Legal Business Name | SJ BLACK ENTERPRISES INC.
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Dates
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Enumeration Date | 03/22/2016
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Last Update Date | 03/22/2016
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Provider Practice Location Address
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Address Line | 298 JEFFERY LN
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City | CABOT
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State | AR
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Zip | 72023-8576
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Country | US
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Telephone | 501-413-8498
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Fax |
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Provider Business Mailing Address
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Address Line | 298 JEFFERY LN
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City | CABOT
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State | AR
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Zip | 72023-8576
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SHERRY BLACK
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Credential | NP
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Telephone | 501-413-8498
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | A001200
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License Number State | AR
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