Individual
JESSICA BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
640 MAY ST, HARLAN, KY 40831-1628
(606) 273-8096
Mailing address
640 MAY ST, HARLAN, KY 40831-1628
(606) 273-8096
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Enumeration date
02/20/2020
Last updated
02/20/2020
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