Active NPI
Jessica K Black, ND
- Naturopath
- McMinnville, OR
National Provider Identifier
1134305337
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Naturopath
- License
- 1263
- Practice address
- 330 SE Baker St
Unit 3
McMinnville, OR 97128-6038 - Phone
- (503) 883-0333
- Fax
- (503) 883-0330
- NPI assigned
- Jan 17, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Naturopath | 175F00000X | 1263 | OR | Primary |
Addresses
Primary practice location
330 SE Baker St
Unit 3
McMinnville, OR 97128-6038
Mailing address
330 SE Baker St
Unit 3
McMinnville, OR 97128-6038
Phone (503) 883-0333
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 234882 | Medicaid | OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1263 | OR | MD | Clinical Psychologist |
Interoperability endpoints
- jessica.black.1@14016.direct.athenahealth.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1200528000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1379030400000",
"number": "1134305337",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "330 SE BAKER ST",
"address_2": "UNIT 3",
"city": "MCMINNVILLE",
"state": "OR",
"postal_code": "971286038",
"telephone_number": "503-883-0333",
"fax_number": "503-883-0330"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "330 SE BAKER ST",
"address_2": "UNIT 3",
"city": "MCMINNVILLE",
"state": "OR",
"postal_code": "971286038",
"telephone_number": "503-883-0333",
"fax_number": "503-883-0330"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACK",
"first_name": "JESSICA",
"middle_name": "K",
"name_prefix": "Dr.",
"credential": "ND",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-01-17",
"last_updated": "2013-09-13",
"status": "A"
},
"taxonomies": [
{
"code": "175F00000X",
"taxonomy_group": "",
"desc": "Naturopath",
"state": "OR",
"license": "1263",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "234882",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in McMinnville, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.