Individual
MS. JENNIFER LYNN BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
24919 S 4420 ROAD, VINITA, OK 74301
(918) 256-9210
(918) 256-6356
Mailing address
24919 S 4420 ROAD, VINITA, OK 74301
(918) 256-9210
(918) 256-6356
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
107607
OK
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
11/03/2020
Last updated
11/03/2020
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