Kisha Renee Black, APRN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

APRN11023957 Issued in FL

Practice address

3625 University Blvd. S.
Jacksonville, FL 32216

Phone

(904) 702-6089

NPI assigned

Mar 7, 2023

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

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Black Bag Medical Inc

  • Family Medicine Physician
  • Jacksonville, FL
  • NPI 1750440988
  Medicare reassignment NPD
• Hni Hospital Services of Florida, LLC

  • Critical Care Medicine (Internal Medicine) Physician
  • Panama City, FL
  • NPI 1144851411

  Family

  Medicare reassignment NPD
• Hni Medical Services of Florida, LLC

  • Internal Medicine Physician
  • Jacksonville, FL
  • NPI 1679048284
  Medicare reassignment NPD
• Jacksonville Hospitalists PA

  • Hospitalist Physician
  • Jacksonville, FL
  • NPI 1871535492
  Medicare reassignment NPD
• Symphony Specialty Group, LLC

  • Specialist
  • Jacksonville, FL
  • NPI 1831878735
  Medicare reassignment NPD
• Kindred Hospitals East, LLC

  • Long Term Care Hospital
  • Green Cove Springs, FL
  • NPI 1134204720
  NPD

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

{
    "created_epoch": "1678147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1760182893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3612 DOUBLE BLANCH LANE",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "32073",
            "telephone_number": "904-536-3680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3625 UNIVERSITY BLVD. S.",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32216",
            "telephone_number": "904-702-6089"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "KISHA",
        "middle_name": "RENEE",
        "name_prefix": "Ms.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-03-07",
        "last_updated": "2023-03-07",
        "certification_date": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "APRN11023957",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Angela Prevatt Black, MD
• Brenda R Black, RN
• Christopher Black
• Dante Black
• Kellam Black, S.L.P.
• Marvin Talmage Black, MS, LMHC
• Meghan Leigh Black, DNP
• Merticia Black
• Michelle Black, CRNA
• Miranda A Black, LPN

• Family Nurse Practitioner in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Family Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.