Active NPI
Kimberly Sue Black, RN
- General Practice Registered Nurse
- Indianapolis, IN
National Provider Identifier
1174042634
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Registered Nurse
- License
- 28097369A
- Practice address
- 7150 Clearvista Dr
Indianapolis, IN 46256-1695 - Phone
- (317) 509-5321
- NPI assigned
- Sep 15, 2017
- 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 |
|---|---|---|---|---|
| General Practice Registered Nurse | 163WG0000X | 28097369A | IN | Primary |
Addresses
Primary practice location
7150 Clearvista Dr
Indianapolis, IN 46256-1695
Mailing address
7150 Clearvista Dr
Indianapolis, IN 46256-1695
Phone (317) 621-5017
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
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28097369A | IN | MD | General Practice Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1505433600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1505433600000",
"number": "1174042634",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7150 CLEARVISTA DR",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462561695",
"telephone_number": "317-621-5017"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7150 CLEARVISTA DR",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462561695",
"telephone_number": "317-509-5321"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACK",
"first_name": "KIMBERLY",
"middle_name": "SUE",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-09-15",
"last_updated": "2017-09-15",
"status": "A"
},
"taxonomies": [
{
"code": "163WG0000X",
"taxonomy_group": "",
"desc": "Registered Nurse, General Practice",
"state": "IN",
"license": "28097369A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.