Individual
MRS. JESSIE BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
608 MASTERSON AVE, CHICKASAW, AL 36611-1618
(251) 689-6356
Mailing address
608 MASTERSON AVE, CHICKASAW, AL 36611-1618
(251) 689-6356
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
906372
MS
363LF0000X
Family Nurse Practitioner
Primary
1-095422
AL
Other
Enumeration date
09/26/2022
Last updated
06/26/2025
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