Jason L Black, APRN-C
Nurse Practitioner, Family in Lebanon, TN. Individual provider (NPI-1).
NPI number1306013305
StatusActive
Last updated in NPPESJun 11, 2020
Details
- NPI
- 1306013305
- Entity type
- Individual (NPI-1)
- Name
- Mr. Jason L Black
- Credential
- APRN-C
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- May 9, 2008
- Certification date
- Jun 11, 2020
- Last updated
- Jun 11, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LF0000X | Nurse Practitioner, Family | 12510 | TN | Yes |
| 363LF0000X | Nurse Practitioner, Family | AP145757 | TX |
Practice location
1407 W Baddour PkwyLebanon, TN 37087-2513
Phone 615-444-6203 · Fax 615-444-6252
Mailing address
1407 W Baddour PkwyLebanon, TN 37087-2513
Phone 615-444-6203 · Fax 615-444-6252
Other practice locations
1600 Us Highway 79 S
Henderson, TX 75654-4508
Henderson, TX 75654-4508
Phone 903-717-3260
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