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NPI Code Detail

MEDICARE: MS. JEAN MARIE BLACK N.P.

MEDICARE: MS. JEAN MARIE BLACK N.P.
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
1363LF0000XFamily Nurse Practitioner0024101703VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1417938416
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JEAN MARIE BLACK N.P.
Provider Business Mailing Address
First Line : 140 CHRISTIANSBURG PIKE
Second Line :
City : FLOYD
State : VA
Zip : 24091-3742
Country : US
Telephone Number : 540-745-9290
Fax Number : 540-745-9294
Provider Business Practice Location Address
First Line : 140 CHRISTIANSBURG PIKE
Second Line :
City : FLOYD
State : VA
Zip : 24091-3742
Country : US
Telephone Number : 540-745-9290
Fax Number : 540-745-9294
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/08/2005
Last Update Date : 05/03/2013

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Directions to “ MS. JEAN MARIE BLACK N.P.” Practice Location

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