Kennedy Black
Individual provider Active NPI Student in an Organized Health Care Education/Training Program · Bismarck, ND
NPI 1023977840 · NPPES record last updated Jan 17, 2026
Key facts
- NPI
- 1023977840
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Student in an Organized Health Care Education/Training Program 390200000X
- Practice address
- 7500 University Dr
Bismarck, ND 58504-9652 - Phone
- (701) 355-8030
- NPI assigned
- Jan 17, 2026
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | ND | Yes | |
| Physical Therapist | 225100000X | ND |
Addresses
Primary practice location
7500 University Dr
Bismarck, ND 58504-9652
Mailing address
9005 Oak Dr
Bismarck, ND 58503-6539
Phone (701) 955-5815
Other providers in Bismarck, ND
- Mark Tucker Bjelland
- Lila Jean Bjerken
- Ryan Bjorgen
- Bjork Dental
- Kevin S. Bjork
- Kirk R Blackwood
- Bladder Care Inc
- Ramsey Blahnik
- Tristen Blake
- Amanda Blanchard
All providers in Bismarck, ND · Student in an Organized Health Care Education/Training Program in North Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 17, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.