Individual
KELLY BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
7100 W 9TH AVE, AMARILLO, TX 79106-1704
(806) 212-0247
Mailing address
5327 N CENTRAL EXPY, STE 200, DALLAS, TX 75205-3345
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
675500
TX
Other
Enumeration date
10/01/2009
Last updated
05/14/2018
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