MEDICARE: KAY CHERENE BLACK APRN-CNS

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	2084P0800X	Psychiatry Physician	CNS00140	NM
2	2084P0802X	Addiction Psychiatry Physician	CNS00140	NM
3	364SP0809X	Adult Psychiatric/Mental Health Clinical Nurse Specialist	33977	OK
4	364SP0809X	Adult Psychiatric/Mental Health Clinical Nurse Specialist	CNS00140	NM

General Provider Information

NPI Number	:	1114959012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAY CHERENE BLACK APRN-CNS

Provider Business Mailing Address
First Line	:	200 MILLBRANCH CT
Second Line	:
City	:	HOT SPRINGS
State	:	AR
Zip	:	71901-7243
Country	:	US
Telephone Number	:	918-530-7257
Fax Number	:	855-595-1072

Provider Business Practice Location Address
First Line	:	200 MILLBRANCH CT
Second Line	:
City	:	HOT SPRINGS
State	:	AR
Zip	:	71901-7243
Country	:	US
Telephone Number	:	918-530-7257
Fax Number	:	855-595-1072

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

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	03/09/2023

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