Individual
DR. KELLY DAWN BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD, MSC
Contact information
Practice address
801 7TH AVE, FORT WORTH, TX 76104-2733
(682) 885-4095
(682) 885-7499
Mailing address
PO BOX 733784, DALLAS, TX 75373-3784
(682) 885-1855
(682) 885-1396
Taxonomy
Speciality
Code
Description
License number
State
207PP0204X
Pediatric Emergency Medicine (Emergency Medicine) Physician
Primary
8697
SD
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
41081
KY
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
MD 6047537
WA
Other
Enumeration date
02/01/2007
Last updated
04/28/2021
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