KELLY RENEE BLACK (NPI# 1508384736) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508384736 |
| Entity Type | Individual |
| Full Name | KELLY RENEE BLACK |
| Practice Address |
503 North Chestnut Street Palmyra PA 17078 |
| Mailing Address |
503 N Chestnut St Palmyra PA 17078-1105 |
| Practice Telephone | 7177561494 |
| Mailing Telephone | 7177561494 |
| Enumeration Date | 2017-09-08 |
| Last Update Date | 2017-09-08 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2255A2300X |
Specialist/Technologist Specialization: Athletic Trainer |
PA | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | |
| Y | 390200000X | Student in an Organized Health Care Education/Training Program | PA | Student, Health Care |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437621091 | Kelly Nicole Black | Nurse Anesthetist, Certified Registered | 11100 Euclid Ave, Anesthesia Dept, Cleveland, OH 44106-5007 | 2018-12-20 |
| 1629527049 | Kelly Black | Physical Therapist | 1114 W Jackson St, Ozark, MO 65721-9164 | 2016-09-27 |
| 1851791966 | Kelly Black | Physical Therapy Assistant | 8540 Scarborough Dr Ste 200, Colorado Springs, CO 80920-7513 | 2014-08-26 |
| 1942550405 | Kelly Black | Occupational Therapist | 4101 Raeford Rd, Fayetteville, NC 28304-4114 | 2012-09-12 |
| 1518278209 | Kelly Soldier Black | Social Worker | 23900 Commerce Park, Beachwood, OH 44122-5822 | 2010-06-28 |
| 1881928299 | Kelly Black | Nurse Anesthetist, Certified Registered | 7100 W 9th Ave, Amarillo, TX 79106-1704 | 2009-10-01 |
| 1659527364 | Kelly Putnam Black | Speech-Language Pathologist | 60 Marietta Rd, Chillicothe, OH 45601-9433 | 2008-08-13 |
| 1700096955 | Kelly Jane Black | Emergency Medicine | 4530 N 32nd St Ste 102, Phoenix, AZ 85018-3357 | 2007-05-23 |
| 1457499592 | Kelly Dawn Black | Emergency Medicine | 801 7th Ave, Fort Worth, TX 76104-2733 | 2007-02-01 |
| Street Address |
503 NORTH CHESTNUT STREET |
| City | PALMYRA |
| State | PA |
| Zip Code | 17078 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558916239 | Lolita Feld | Family Medicine | 941 Park Drive, Palmyra, PA 17078 | 2019-08-08 |
| 1174857643 | Jason John Castro | Occupational Therapist | 1273 South Forge Road, Palmyra, PA 17078 | 2009-09-30 |
| 1962694174 | Timothy Ryan Corl | Optometrist | 2901 Horseshoe Pike, Palmyra, PA 17078 | 2007-08-11 |
| 1740349216 | Ck Kc Inc | Pharmacy | 22 East Main Street, Palmyra Pharmacy & Gift Shop, Palmyra, PA 17078 | 2006-12-08 |
| 1396839742 | Khanh T. Bui | Pharmacist | 30 W. Main Street, Palmyra, PA 17078 | 2006-10-02 |
| 1548369028 | Ck-kc Ltc, Inc | Pharmacy | 1200 Grubb Street, Palmyra, PA 17078 | 2006-09-21 |
| 1669846507 | Kelly Christine Morris | Occupational Therapist | 2880 Horseshoe Pike, Palmyra, PA 17078 | 2015-11-16 |
| 1003287558 | Corl Eyecare, LLC | Optometrist | 2901 Horseshoe Pike, Palmyra, PA 17078 | 2015-10-09 |
| 1972727238 | Philhaven Residential | Psychiatric Residential Treatment Facility | 231 E Main St, Palmyra, PA 17078 | 2007-04-11 |
| 1982016218 | Mary Jane Spahr | Counselor | 626 N Chestnut St, Palmyra, PA 17078-1106 | 2014-05-21 |
| Find all providers in zip 17078 | ||||
| Taxonomy Code | 390200000X |
| Grouping | Student, Health Care |
| Classification | Student in an Organized Health Care Education/Training Program |
| An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |
| Notes: [1/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639770829 | Michelle Morris | Student in an Organized Health Care Education/Training Program | Dept. of Family Medicine & Community Health, 3737 Market, Philadelphia, PA 19104 | 2020-11-04 |
| 1356942825 | Aisha Ghauri | Student in an Organized Health Care Education/Training Program | 645 Springhouse Ln, Hummelstown, PA 17036-7009 | 2020-11-02 |
| 1891395828 | Roopali Mahajan | Student in an Organized Health Care Education/Training Program | 4101 Spruce St Apt 108, Philadelphia, PA 19104-4059 | 2020-10-28 |
| 1629678925 | Jonathan Welch | Student in an Organized Health Care Education/Training Program | 4200 E City Ave, Rowland Hall, Suite 207, Physician Assistant Department, Philadelphia, PA 19131 | 2020-10-27 |
| 1093313157 | Betty M Beimel | Student in an Organized Health Care Education/Training Program | 5966 Route 66, Kane, PA 16735-3434 | 2020-10-12 |
| 1104432616 | Zach Quince | Student in an Organized Health Care Education/Training Program | 370 Birch St, Imperial, PA 15126-1158 | 2020-09-20 |
| 1073129862 | Philip Andrus | Student in an Organized Health Care Education/Training Program | 3420 Forbes Ave Fl 2, Pittsburgh, PA 15213-3203 | 2020-09-17 |
| 1992310049 | Rachana Amin | Student in an Organized Health Care Education/Training Program | 12 Fitzgerald Dr, Moosic, PA 18507-2105 | 2020-09-14 |
| 1992310767 | Natasha Ann Parrish | Student in an Organized Health Care Education/Training Program | Millersville University, School of Social Work, Strayer, 37 W. Frederick Street, Millersville, PA 17551 | 2020-09-09 |
| 1205440138 | Beth Ann Wagner | Student in an Organized Health Care Education/Training Program | 1444 E Main St, Douglassville, PA 19518-9116 | 2020-09-08 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on KELLY RENEE BLACK.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.