Individual
CARRIE JUNE BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
1756 E CENTER ST, MADISONVILLE, KY 42431-2253
(270) 821-3300
(270) 821-2100
Mailing address
200 CLINIC DR, MADISONVILLE, KY 42431-1661
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
3002209
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000044303
BCBS PROVIDER NUMBER
—
01
—
2209P
LICENSE
KY
05
—
78001153
—
KY
01
—
P00943823
RAILROAD MEDICARE- WALMART MADISONVILLE
KY
Enumeration date
09/17/2006
Last updated
12/08/2020
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