Kimberly Lucille Black, PMHNP
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Monett, MO
NPI 1255878989 · NPPES record last updated Feb 28, 2017
Key facts
- NPI
- 1255878989
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 2017004149 (MO)
- Practice address
- 411 3Rd St
Monett, MO 65708-2008 - Phone
- (417) 476-1000
- Fax
- (417) 476-1082
- NPI assigned
- Jan 19, 2017
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2016
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Ozark Tri-County Health Care Consortium
Practice addresses (Care Compare)
530 S Maiden LN
Joplin, MO 64801-3084
Phone (417) 782-6200
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170308001746 | MO | Practitioner - Nurse Practitioner | 4880978907 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2017004149 | MO | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Clark Community Mental Health Center | Current |
Accepting new patients | |
| Ozark Tri-County Health Care Consortium | Current |
Accepting new patients | |
| Ozark Tri-County Health Care Consortium | Current |
Accepting new patients | |
| Clark Community Mentalhealth Center | Past |
Accepting new patients |
Locations
927 N Highway 71
Anderson, MO 64831
Phone (417) 845-2273
1810 S Carnation Dr
Aurora, MO 65605
Phone (417) 678-1260
4016 Main St
Cassville, MO 65625
Phone (417) 847-0057
123 N Wetzel St
Greenfield, MO 65661
Phone (417) 637-0129
530 S Maiden Ln
Joplin, MO 64801
Phone (417) 223-4385
210 W 10th St
Lamar, MO 64759
Phone (417) 681-0027
411 3rd St
Monett, MO 65708
Phone (417) 235-6610
1701 N Central Ave
Monett, MO 65708
Phone (417) 235-6610
1504 N Business 49
#A
Neosho, MO 64850
Phone (417) 346-1201
104 W Main St
Pierce City, MO 65723
Phone (417) 235-6610
202 E 8th St
Pineville, MO 64856
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 2017004149 | MO | Yes |
Addresses
Primary practice location
411 3Rd St
Monett, MO 65708-2008
Mailing address
PO Box 100
Pierce City, MO 65723-2100
Phone (417) 476-1000
Other providers in Monett, MO
- Shane Micheal Becker
- Melanie Nicole Beckham
- Benchmark Healthcare of Monett, LLC
- Lacey Berry
- Earl Best
- Vickie Lynn Blevins
- Brook Beaumont Bounous
- Charles Bret Bowling
- Allison Elizabeth Brewer
- Paul H. Bricker
All providers in Monett, MO · Psychiatric/Mental Health Nurse Practitioner in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 28, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.