SKYELOR BLACK
NPI 1124723275
Student in an Organized Health Care Education/Training Program in Chattanooga, TN

Q: What is Skyelor Black's NPI number?

The NPI number for Skyelor Black is 1124723275. It was assigned to this individual provider in the NPPES registry on March 30, 2023.

Q: What is Skyelor Black's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Q: When was this NPI record last updated?

The NPPES record for Skyelor Black was last updated on March 30, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since March 30, 2023PECOS Enrolled

975 E 3RD ST # 112, CHATTANOOGA, TN 37403(423) 778-7817 Get Directions Write a Review

NPPES record last updated: March 30, 2023. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Skyelor Black NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SKYELOR BLACK (NPI 1124723275) is an individual student in an organized health care education/training program in Chattanooga, Tennessee and active in the NPI registry since March 2023. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1124723275

Entity TypeIndividualMale

Primary Taxonomy390200000X

Provider Legal NameSKYELOR BLACK

Location Address975 E 3RD ST # 112Chattanooga, TN 37403-2173

Mailing Address975 E 3rd St # 112Chattanooga, TN 37403-2173

Phone(423) 778-7817

Sole ProprietorNo

Enumeration DateMarch 30, 2023

NPPES CertifiedMarch 30, 2023

✔ NPI 1124723275 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care

Taxonomy Code390200000X

Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

975 E 3RD ST # 112, Chattanooga, TN 37403

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Skyelor Black is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer– Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

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Other Providers at the Same Location NPPES 15

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ADAM CARLTON VOLLBERG MD

Student in an Organized Health Care Education/Training Program