Basic Information
| Provider Information | |||||||||
| NPI: | 1437324316 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BLACK | ||||||||
| FirstName: | BARBARA | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4601 CHARLOTTE PARK DR | ||||||||
| Address2: | SUITE 390 | ||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282171915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7045296161 | ||||||||
| FaxNumber: | 7043237931 | ||||||||
| Practice Location | |||||||||
| Address1: | 114 HOLLOWELL RD | ||||||||
| Address2: | |||||||||
| City: | AULANDER | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278059634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2523453791 | ||||||||
| FaxNumber: | 2523450480 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2008 | ||||||||
| LastUpdateDate: | 02/16/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 17666 | CA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 5004617 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.