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General NPI Number Information
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NPI Number | 1710347943
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Entity Type | Individual
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Provider Name | JENNIFER LEIGH BLACK APRN
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Gender | Female
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Dates
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Enumeration Date | 03/01/2016
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Last Update Date | 08/06/2025
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Provider Practice Location Address
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Address Line | 16000 CHRISTENSEN RD STE 200
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City | TUKWILA
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State | WA
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Zip | 98188-2925
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Country | US
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Telephone | 833-719-0886
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Fax | 702-589-4872
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Provider Business Mailing Address
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Address Line | 16000 CHRISTENSEN RD STE 200
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City | TUKWILA
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State | WA
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Zip | 98188-2925
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Country | US
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Telephone | 702-483-5020
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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 | A149915
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 70003309-NP
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | G166344
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License Number State | IA
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