Provider Demographics
NPI:1114959012
Name:BLACK, KAY CHERENE (APRN-CNS)
Entity Type:Individual
Prefix:
First Name:KAY
Middle Name:CHERENE
Last Name:BLACK
Suffix:
Gender:F
Credentials:APRN-CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MILLBRANCH CT
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901-7243
Mailing Address - Country:US
Mailing Address - Phone:918-530-7257
Mailing Address - Fax:855-595-1072
Practice Address - Street 1:200 MILLBRANCH CT
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-7243
Practice Address - Country:US
Practice Address - Phone:918-530-7257
Practice Address - Fax:855-595-1072
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNS001402084P0800X, 2084P0802X, 364SP0809X
OK33977364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKOKAAA2963Medicare PIN