Individual
MRS. AMY L BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
30381 CHIEFTAIN DR, LOGAN, OH 43138-9092
(740) 385-2555
(740) 380-3750
Mailing address
PO BOX 188, CHILLICOTHE, OH 45601-0188
(740) 773-4366
(740) 775-7855
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN275748- COA1
OH
363LP2300X
Primary Care Nurse Practitioner
NP-11608
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3124318
—
OH
Enumeration date
08/12/2010
Last updated
11/04/2019
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