Kelly Jane Black, MD

Primary specialty

Sports Medicine (Emergency Medicine) PhysicianTaxonomy code 207PS0010X

License

24733 Issued in AZ

Practice address

4530 N 32ND St Ste 102
Phoenix, AZ 85018-3357

Phone

(602) 493-1626

NPI assigned

May 23, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1700096955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3119 E PUGET AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850285328",
            "telephone_number": "602-493-1626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4530 N 32ND ST STE 102",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850183357",
            "telephone_number": "602-493-1626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "KELLY",
        "middle_name": "JANE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207PS0010X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Sports Medicine",
            "state": "AZ",
            "license": "24733",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Delbert Roger Black, MD
• Evelyn Black
• Farrah L Black, PA
• Karen Black
• Katheryn K Black, DO
• Margaret A Black
• Natalie Black, MOT
• Sheri L Black, RN,BSN
• Abigail Hedy Blackburn Green
• Paul A. Blackburn, DO

• Sports Medicine (Emergency Medicine) Physician in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Sports Medicine (Emergency Medicine) Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.