# KELLY BLACK

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1912653536
- **Gender:** F
- **Credential:** PMHNP-BC

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163WP0808X | Psychiatric/Mental Health Registered Nurse | 56220 | CA | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | 305924 | AZ | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | 95024873 | CA | Yes |

## Other

- **Enumeration date:** 02/22/2022
- **Last updated:** 02/06/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 305924 | ARIZONA BOARD OF NURSING CERTIFIED NURSE PRACTITIONER LICENSE PMHNP-BC | AZ |