Basic Information
| Provider Information | |||||||||
| NPI: | 1598422578 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BLACK | ||||||||
| FirstName: | BREONA | ||||||||
| MiddleName: | LASHAWN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 844 19TH ST SE | ||||||||
| Address2: | |||||||||
| City: | PARIS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 754607515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9034916563 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6609 VIRGINIA PKWY | ||||||||
| Address2: | |||||||||
| City: | MCKINNEY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750715513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9725428884 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/24/2021 | ||||||||
| LastUpdateDate: | 12/14/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | 1060449 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | 163WX0003X | 926806 | TX | N | Nursing Service Providers | Registered Nurse | Obstetric, Inpatient |
No ID Information.