NPI 1902496540 · live from the CMS NPI Registry
Jordan Black, CPNP-PC
Nurse Practitioner, Pediatrics in Town And Country, MO. National Provider Identifier 1902496540, active.
NPI record
| NPI | 1902496540 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Nurse Practitioner, Pediatrics 363LP0200X |
| Practice location | 13001 N Outer 40 Rd, Town And Country, MO 63017 |
| Practice phone | 314-454-5437 |
| Enumerated | January 18, 2021 |
| Last updated | July 10, 2023 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Nurse Practitioner, Pediatrics primary | 363LP0200X | 2020021017 (MO) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.