Individual
MRS. BRIANNE ELLIS BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1648 CARTER ST STE 2, VIDALIA, LA 71373-3111
(318) 414-2315
(318) 414-5250
Mailing address
1648 CARTER ST, VIDALIA, LA 71373-3111
(318) 607-5870
(318) 607-5870
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
202115
LA
363LF0000X
Family Nurse Practitioner
907575
MS
Other
Enumeration date
06/11/2025
Last updated
08/01/2025
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