Black, Amy L

Black, Amy L is an individual health care provider with primary practice located at 30381 Chieftain Dr , Logan OH 43138-9092. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Primary Care, Physician Assistants & Advanced Practice Nursing Providers / Family. Physician Assistants & Advanced Practice Nursing Providers / Family is her primary health care specialty. Black, Amy L can be contacted via phone (740) 385-2555.

Contact Information

Primary practice address
30381 Chieftain Dr Logan OH 43138-9092
Phone: (740) 385-2555
Fax: (740) 380-3750
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Primary Care 363LP2300X NP-11608 Ohio
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X RN275748- COA1 Ohio

Profile Details

NPI number 1033424148
LBN Legal business name Black, Amy L
Credentials Certified Nurse Practitioner (CNP)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 12th, 2010
Last updated Nov 4th, 2019 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1033424148 NPPES
Ohio MEDICAID 3124318

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