| Doctor Name: | MS. JEAN MARIE BLACK |
| NPI Number: | 1417938416 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | N.P. |
| License Number: | 0024101703 |
| Business Practice Address: | 140 Christiansburg Pike Floyd, VA - 240913742 |
| Business Phone Number: | 5407459290 |
| Business Fax Number: | 5407459294 |
| Mailing Address: | 140 Christiansburg Pike, FLOYD |
| State: | VA |
| Postal Code: | 240913742 |
| Phone Number: | 5407459290 |
| Fax Number: | 5407459294 |
| NPI Enumeration Date: | 11/08/2005 |
| NPI Last Update Date: | 05/03/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 0024101703 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |