Individual
KATY A BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
211 E MAIN ST, CARBONDALE, KS 66414-9607
(785) 836-7111
(785) 836-9251
Mailing address
211 E MAIN ST, CARBONDALE, KS 66414-9607
(785) 836-7111
(785) 836-9251
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
76631
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
068002294
MEDICARE
KS
05
—
201108160A
—
KS
05
—
30004450320001
—
KS
Enumeration date
12/31/2014
Last updated
03/06/2026
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