MEDICARE: CIERRA CHARRSE BLACK PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant		TX

General Provider Information

NPI Number	:	1104625383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CIERRA CHARRSE BLACK PA-C

Provider Business Mailing Address
First Line	:	2400 EATON DR
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75072-8825
Country	:	US
Telephone Number	:	214-250-4924
Fax Number	:

Provider Business Practice Location Address
First Line	:	1411 N BECKLEY AVE STE 363
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75203-1558
Country	:	US
Telephone Number	:	214-305-8667
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/11/2025
Last Update Date	:	03/11/2025

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Directions to “ CIERRA CHARRSE BLACK PA-C” Practice Location

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