Individual
MS. JORDAN BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP-PC
Contact information
Practice address
13001 N OUTER 40 RD, TOWN AND COUNTRY, MO 63017-5941
(314) 454-5437
Mailing address
13001 N OUTER 40 RD, TOWN AND COUNTRY, MO 63017-5941
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
2020021017
MO
Other
Enumeration date
01/18/2021
Last updated
07/10/2023
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