Provider Demographics
NPI:1831231315
Name:BLACK, SHIRLEY HANLEY (ARNP)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:HANLEY
Last Name:BLACK
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 WALNUT
Mailing Address - Street 2:P.O. BOX 578
Mailing Address - City:CEDAR VALE
Mailing Address - State:KS
Mailing Address - Zip Code:67024
Mailing Address - Country:US
Mailing Address - Phone:620-758-2221
Mailing Address - Fax:620-758-2468
Practice Address - Street 1:300 W NORTH ST
Practice Address - Street 2:
Practice Address - City:SEDAN
Practice Address - State:KS
Practice Address - Zip Code:67361-1051
Practice Address - Country:US
Practice Address - Phone:620-725-3818
Practice Address - Fax:620-725-5433
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS45993363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner