Individual
GABRIELLE MIRE BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
4402 U S HIGHWAY 167, MAURICE, LA 70555-3708
(337) 516-3110
Mailing address
3420 KIRK RD, MAURICE, LA 70555-3417
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
348969
LA
Other
Enumeration date
10/16/2025
Last updated
10/16/2025
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