Provider Demographics
NPI:1366617854
Name:BLACK, CHERYL C (APRN-BC)
Entity type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:C
Last Name:BLACK
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 INDUSTRIAL LN
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:TN
Mailing Address - Zip Code:37841-6294
Mailing Address - Country:US
Mailing Address - Phone:423-286-4141
Mailing Address - Fax:423-286-4145
Practice Address - Street 1:715 RUGBY HWY
Practice Address - Street 2:
Practice Address - City:ROBBINS
Practice Address - State:TN
Practice Address - Zip Code:37852-3755
Practice Address - Country:US
Practice Address - Phone:423-627-2782
Practice Address - Fax:423-627-2188
Is Sole Proprietor?:No
Enumeration Date:2008-04-25
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13431363LF0000X
TNAPN13431363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN13431OtherAPRN LICENSE
TNRN0000111356OtherRN LICENSE
TN1513674Medicaid
TN13431OtherAPRN LICENSE
TN1513674Medicaid