Individual
MR. JASON L BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN-C
Contact information
Practice address
1407 W BADDOUR PKWY, LEBANON, TN 37087-2513
(615) 444-6203
(615) 444-6252
Mailing address
1407 W BADDOUR PKWY, LEBANON, TN 37087-2513
(615) 444-6203
(615) 444-6252
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
12510
TN
363LF0000X
Family Nurse Practitioner
AP145757
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12242516
CAQH
TN
01
—
12510
ADVANCED PRACTICE NURSE NUMBER
TN
01
—
141492
TN REGISTERED NURSE
TN
05
—
1524683
—
TN
01
—
1671330
CIGNA
TN
01
—
270851352
AETNA
TN
01
—
3323078
UHC
TN
01
—
4298132
BCBS
TN
01
—
62-1792161
TRICARE
TN
Enumeration date
05/09/2008
Last updated
06/11/2020
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