Individual
JAMIE BLACK
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1720 NICHOLASVILLE RD, SUITE 502, LEXINGTON, KY 40503-1475
(859) 277-7129
(859) 277-9613
Mailing address
1720 NICHOLASVILLE RD, SUITE 502, LEXINGTON, KY 40503-1475
(859) 277-7129
(859) 277-9613
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA690
KY
Other
Enumeration date
05/13/2006
Last updated
07/08/2007
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