Carolyn Margaret Black, ATC
Individual provider Active NPI Athletic Trainer · Wasilla, AK
NPI 1245461540 · NPPES record last updated Jul 1, 2014
Key facts
- NPI
- 1245461540
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- License
- 119902014 (AK)
- Practice address
- 1001 E Bogard Rd
Wasilla, AK 99654-7114 - Phone
- (907) 376-2225
- Fax
- (907) 376-9225
- NPI assigned
- Aug 4, 2009
- 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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 119902014 | AK | MD | Athletic Trainer |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 119902014 | AK | Yes |
Addresses
Primary practice location
1001 E Bogard Rd
Wasilla, AK 99654-7114
Mailing address
1001 E Bogard Rd
Wasilla, AK 99654-7114
Phone (907) 376-2225
Other providers in Wasilla, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 1, 2014. 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.