Provider Demographics
NPI:1992719603
Name:BLACK, CATHERINE J (MSN, ARNP, CPNP)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:J
Last Name:BLACK
Suffix:
Gender:F
Credentials:MSN, ARNP, CPNP
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:JANE
Other - Last Name:FAUST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, MSN, APRN, CPNP
Mailing Address - Street 1:5515 WEST 81ST TERRACE
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208
Mailing Address - Country:US
Mailing Address - Phone:913-649-0880
Mailing Address - Fax:
Practice Address - Street 1:2401 GILLHAM RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-4619
Practice Address - Country:US
Practice Address - Phone:816-860-3080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO121959363LP0200X
KS44615363LP0200X
KS1341691052363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100342480AMedicaid
MO424641801Medicaid