AUTUMN BLACK

LOUISVILLE, KY
NPI1376137414
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy363LF0000X Nurse Practitioner, Family
(Licence: KY  3014903)
Enumeration Date2021-03-01
Last Update Date2022-11-17
Business Address
AUTUMN BLACK
2100 MILLVALE RD
LOUISVILLE, KY 40205-1604
Phone number: 443-383-9300
Mailing Address
AUTUMN BLACK
909 RIDGEBROOK RD STE 300
SPARKS, MD 21152-9477
Phone number: 443-383-9300
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