Individual
KYE BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
528 SOUTH AVE, GRETNA, NE 68028-4500
(402) 904-2612
Mailing address
209 W PAULDING RD, FORT WAYNE, IN 46807-3426
(616) 368-7920
Taxonomy
Speciality
Code
Description
License number
State
373H00000X
Day Training/Habilitation Specialist
Primary
—
—
Other
Enumeration date
03/14/2025
Last updated
03/14/2025
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