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Individual
DR. RILEY MACKENZIE BLACK
Active
Individual
DR. RILEY MACKENZIE BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DNP
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
LIC103602
MT
363L00000X
Nurse Practitioner
Primary
NUR-APRN-LIC-240991
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0801419904108
DRIVERS LICENSE
MT
Enumeration date
01/30/2023
Last updated
09/13/2024
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