Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 5014633 | NC |
NPI | 1023688116 |
---|---|
Provider Name | Mrs. Megan Kathleen Black |
First Address | Cary, NC 27513-2024 |
Second Address | Cary, NC 27518-6679 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2021 |
Last Update Date | 30/06/2021 |