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General NPI Number Information
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NPI Number | 1649943937
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Entity Type | Individual
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Provider Name | ALEXIS BLACK CNP
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Gender | Female
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Dates
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Enumeration Date | 08/01/2021
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Last Update Date | 08/20/2021
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Provider Practice Location Address
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Address Line | 1057 PAUL MAILLARD RD STE D-1900
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City | LULING
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State | LA
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Zip | 70070-4349
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Country | US
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Telephone | 985-785-3668
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Fax |
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Provider Business Mailing Address
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Address Line | 209 E PIN OAK DR
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City | SAINT ROSE
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State | LA
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Zip | 70087-3239
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Country | US
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Telephone | 504-554-3034
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 221427
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License Number State | LA
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