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Individual

CAROL LYNN BLACK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
APRN-CNP

Contact information

Practice address
107 E POST AVE, COALGATE, OK 74538-3004
(580) 927-2828
(580) 927-9876
Mailing address
610 E 24TH ST, TISHOMINGO, OK 73460-3245
(580) 371-2343
(580) 371-3614

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
67047
OK
363LF0000X
Family Nurse Practitioner
Primary
R0067047
OK

Other

Enumeration date
10/03/2017
Last updated
12/19/2022
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