Individual provider · NPI-1

Timonthy Donell Black

Nurse Practitioner, Family · Mount Airy, NC

NPI number1992396022
StatusActive
Last updated in NPPESMay 16, 2024

Details

NPI
1992396022
Entity type
Individual (NPI-1)
Name
Timonthy Donell Black
Sex
Male
Sole proprietor
Yes
Enumeration date
Feb 1, 2021
Certification date
May 16, 2024
Last updated
May 16, 2024

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
363LF0000X Nurse Practitioner, Family5014067NCYes
390200000X Student in an Organized Health Care Education/Training Program––

Practice location

113 Scenic Outlet Ln Ste 2
Mount Airy, NC 27030-9978

Phone 336-352-4900 · Fax 336-352-4901

Mailing address

1132 Carter Mountain Rd
Stuart, VA 24171-3769

Phone 336-345-6731

Other practice locations

1132 Carter Mountain Rd
Stuart, VA 24171-3769

Phone 336-345-6731

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