| Jackie Evans Black, RN | |
|
151 S University Ave # 1900, Provo, UT 84601-4427 | |
| (801) 851-7026 | |
| (801) 343-8725 |
| Full Name | Jackie Evans Black |
|---|---|
| Gender | Female |
| Speciality | Registered Nurse - Community Health |
| Location | 151 S University Ave # 1900, Provo, Utah |
| Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629144308 | NPI | - | NPPES |
| 998877660009 | Medicaid | UT | |
| QM0000039389 | Other | UT | ALTIUS PROVIDER# |
| 55102 | Other | UT | PEHP PROVIDER # |
| 103003506102 | Other | UT | SELECT HEALTH PROVIDER # |
| PR00489 | Medicaid | UT | |
| 73-00012 | Other | UT | UNITED HEALTHCARE ID# |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 163WC1500X | Registered Nurse - Community Health | 218040-3102 (Utah) | Primary |
| Mailing Address | Practice Location Address |
|---|---|
| Jackie Evans Black, RN 265 E 200 S, Salem, UT 84653-9452 Ph: (801) 423-2373 | Jackie Evans Black, RN 151 S University Ave # 1900, Provo, UT 84601-4427 Ph: (801) 851-7026 |
Katherine Denise Koller, APRN Registered Nurse Medicare: Not Enrolled in Medicare Practice Location: 315 S 100 E, Provo, UT 84606 Phone: 801-851-8517 | |
Stacey Ann Hinckley, RN Registered Nurse Medicare: Not Enrolled in Medicare Practice Location: 750 N Freedom Blvd, Provo, UT 84601 Phone: 801-373-4760 | |
Merry Jane Lee, RN Registered Nurse Medicare: Not Enrolled in Medicare Practice Location: 3278 Mohican Way, Provo, UT 84604 Phone: 801-691-3625 | |
Andrew James Dawe, RN Registered Nurse Medicare: Not Enrolled in Medicare Practice Location: 750 N Freedom Blvd, Provo, UT 84601 Phone: 801-373-4760 | |
Wendy F. Kanno, RN Registered Nurse Medicare: Not Enrolled in Medicare Practice Location: 1034 N 500 W, Provo, UT 84604 Phone: 801-373-7850 Fax: 801-357-7997 | |
Nereida Rodriguez, RN Registered Nurse Medicare: Not Enrolled in Medicare Practice Location: 151 S University Ave # 1900, Provo, UT 84601 Phone: 801-851-7090 Fax: 801-343-8724 | |
Camilla Shaffer, RN Registered Nurse Medicare: Not Enrolled in Medicare Practice Location: 151 S University Ave, Provo, UT 84601 Phone: 801-851-7000 |