Organization
KJB ANESTHESIA, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY J BLACK CRNA (OWNER)
(866) 877-2762
Entity
Organization
Contact information
Practice address
1010 S COULTER ST, AMARILLO, TX 79106-1781
(866) 877-2762
(866) 992-7144
Mailing address
PO BOX 6467, FLORENCE, SC 29502-6467
(866) 877-2762
(866) 992-7144
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
212211106
—
TX
Enumeration date
06/30/2021
Last updated
06/30/2021
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