Provider Demographics
NPI:1568403590
Name:BLACK, KATHRYN H (CNS)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:H
Last Name:BLACK
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1280 COLUMBIANA RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35216-1642
Mailing Address - Country:US
Mailing Address - Phone:205-599-3540
Mailing Address - Fax:205-599-2230
Practice Address - Street 1:2022 BROOKWOOD MEDICAL CTR DR
Practice Address - Street 2:SUITE 510
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-6808
Practice Address - Country:US
Practice Address - Phone:205-877-9290
Practice Address - Fax:205-599-2224
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2007-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-025776163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALS61403Medicare UPIN