Ivy Black, C-NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

RN195496 Issued in GA

Practice address

2782 Cobb Pkwy NW
Kennesaw, GA 30152-3472

Phone

(706) 405-1195

NPI assigned

Feb 15, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Minuteclinic LLCGroup PAC ID 6709850241, 576 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner, Nurse Practitioner

State licenses

Practice roles

Locations

Networks

• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H3359

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Minuteclinic LLC

  • Family Nurse Practitioner
  • Rockville, MD
  • NPI 1134191836

  GA

  Medicare reassignment Care Compare group NPD
• Primary Care PLLC

  • Family Nurse Practitioner
  • Spring, TX
  • NPI 1770354763

  GA

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1644883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749686400000",
    "number": "1104571462",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2782 COBB PKWY NW",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301523472",
            "telephone_number": "706-405-1195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2782 COBB PKWY NW",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301523472",
            "telephone_number": "706-405-1195"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "IVY",
        "credential": "C-NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-02-15",
        "last_updated": "2025-06-12",
        "certification_date": "2025-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN195496",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Big Idea Family Chiropractic Center
• Sarah Bigelow, LAPC
• Catherine Birchfield
• Scott Edward Bisch
• Abhiyan Jung Bista, MD
• Courtney Blackwell, MS, BCBA
• Alysia Blair
• Shanice Blair
• Alyssa Loren Blake
• Roy Alln Blankenship, LPC,LMFT,CCADC, CSAT

• Family Nurse Practitioner in Kennesaw, GA
• Providers in Kennesaw, GA by specialty
• Family Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.