Individual
KENNETH BRYAN BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
REGISTERED NURSE
Contact information
Practice address
6401 STONEHAM DR, AMARILLO, TX 79109-6438
(806) 206-6823
Mailing address
6401 STONEHAM DR, AMARILLO, TX 79109-6438
(806) 206-6823
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
857787
TX
Other
Enumeration date
08/26/2015
Last updated
08/26/2015
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