Active NPI
Kiley Elizabeth Black, NP
- Nurse Practitioner
- Minneapolis, MN
National Provider Identifier
1306989405
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- R 1403224
- Practice address
- 2545 Chicago Ave
Suite 601
Minneapolis, MN 55404-4522 - Phone
- (612) 863-7770
- Fax
- (612) 863-7772
- NPI assigned
- Feb 15, 2007
- 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 |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | R 1403224 | MN | Primary |
Addresses
Primary practice location
2545 Chicago Ave
Suite 601
Minneapolis, MN 55404-4522
Mailing address
2545 Chicago Ave
Suite 601
Minneapolis, MN 55404-4522
Phone (612) 863-7770
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)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R 1403224 | MN | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171497600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1282003200000",
"number": "1306989405",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2545 CHICAGO AVE",
"address_2": "SUITE 601",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554044522",
"telephone_number": "612-863-7770",
"fax_number": "612-863-7772"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2545 CHICAGO AVE",
"address_2": "SUITE 601",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554044522",
"telephone_number": "612-863-7770",
"fax_number": "612-863-7772"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACK",
"first_name": "KILEY",
"middle_name": "ELIZABETH",
"name_prefix": "Ms.",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-15",
"last_updated": "2010-08-17",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "MN",
"license": "R 1403224",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.