Elicia Black, ATC
Specialist/Technologist, Athletic Trainer in Missouri City, TX. Individual provider (NPI-1).
NPI number1639620347
StatusActive
Last updated in NPPESApr 26, 2024
Details
- NPI
- 1639620347
- Entity type
- Individual (NPI-1)
- Name
- Elicia Black
- Credential
- ATC
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Oct 18, 2016
- Certification date
- Apr 26, 2024
- Last updated
- Apr 26, 2024
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2255A2300X | Specialist/Technologist, Athletic Trainer | 7479 | TX | Yes |
Practice location
2518 Valley Forest DrMissouri City, TX 77489-6005
Phone 281-299-8404
Mailing address
2518 Valley Forest DrMissouri City, TX 77489-6005
Phone 281-299-8404
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This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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