Provider Demographics
NPI:1104625383
Name:BLACK, CIERRA CHARRSE (PA-C)
Entity type:Individual
Prefix:
First Name:CIERRA
Middle Name:CHARRSE
Last Name:BLACK
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 EATON DR
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75072-8825
Mailing Address - Country:US
Mailing Address - Phone:214-250-4924
Mailing Address - Fax:
Practice Address - Street 1:1411 N BECKLEY AVE STE 363
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75203-1558
Practice Address - Country:US
Practice Address - Phone:214-305-8667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant