Black, Jennifer K

Black, Jennifer K is an individual health care provider with primary practice located at 619 E Mason St Suite 4P57, Springfield IL 62701-1034. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Interventional Cardiology, Physician Assistants & Advanced Practice Nursing Providers / Adult Health. Physician Assistants & Advanced Practice Nursing Providers / Adult Health is her primary health care specialty. Black, Jennifer K can be contacted via phone (217) 788-0706.

Contact Information

Primary practice address
619 E Mason St Suite 4P57 Springfield IL 62701-1034
Phone: (217) 788-0706
Fax: (217) 525-2535
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Interventional Cardiology 207RI0011X 209002373 Illinois
Physician Assistants & Advanced Practice Nursing Providers / Adult Health 363LA2200X 209002373 Illinois

Profile Details

NPI number 1174607576
LBN Legal business name Black, Jennifer K
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 24th, 2006
Last updated Dec 20th, 2021 - about 3 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 1174607576 NPPES
Illinois Other 596500 RAILROAD

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