Individual provider · NPI-1

Kristin Black

Family Medicine · Morgantown, WV

NPI number1902251374
StatusActive
Last updated in NPPESMar 14, 2024

Details

NPI
1902251374
Entity type
Individual (NPI-1)
Name
Kristin Black
Sex
Female
Sole proprietor
No
Enumeration date
May 4, 2016
Certification date
Mar 14, 2024
Last updated
Mar 14, 2024

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Q00000X Family Medicine3370WVYes
207P00000X Emergency Medicine3370WV

Practice location

2601 Cranberry Sq
Morgantown, WV 26508-9201

Phone 304-285-1702 · Fax 304-285-1918

Mailing address

527 Medical Park Dr
Ste 500
Bridgeport, WV 26330-9008

Phone 681-342-3600 · Fax 681-342-3625

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