Individual
MS. THERESA ANN BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
11 N LOCUST ST, BUCKHANNON, WV 26201-4707
(304) 472-1600
Mailing address
812 GORMAN AVENUE, ELKINS, WV 26241
(304) 637-3456
(304) 637-3441
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
49062
WV
363LF0000X
Family Nurse Practitioner
Primary
49062
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810009382
—
WV
Enumeration date
06/29/2007
Last updated
11/29/2023
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