Individual provider · NPI-1

Kimberly Sue Black, Rn

Registered Nurse, General Practice · Indianapolis, IN

NPI number1174042634
StatusActive
Last updated in NPPESSep 15, 2017

Details

NPI
1174042634
Entity type
Individual (NPI-1)
Name
Kimberly Sue Black
Credential
Rn
Sex
Female
Sole proprietor
No
Enumeration date
Sep 15, 2017
Last updated
Sep 15, 2017

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
163WG0000X Registered Nurse, General Practice28097369aINYes

Practice location

7150 Clearvista Dr
Indianapolis, IN 46256-1695

Phone 317-509-5321

Mailing address

7150 Clearvista Dr
Indianapolis, IN 46256-1695

Phone 317-621-5017

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