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JACKIE EVANS BLACK RN
NPI 1629144308
Registered Nurse - Community Health in Provo, UT

Active since November 27, 2006
151 S UNIVERSITY AVE # 1900, PROVO, UT 84601(801) 851-7026(801) 343-8725 Get Directions Write a Review

NPPES record last updated: July 9, 2007. Verified against the NPPES registry weekly; last sync: August 30, 2026.

About Jackie Evans Black Rn NPPES

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

JACKIE EVANS BLACK RN (NPI 1629144308) is an individual community health provider in Provo, Utah, licensed in Utah (218040-3102) and active in the NPI registry since November 2006.

NPPES Registry Identity

NPI1629144308
Entity TypeIndividualFemale
Primary Taxonomy163WC1500X
Provider Legal NameJACKIE EVANS BLACKCredential: RN
Location Address151 S UNIVERSITY AVE # 1900Provo, UT 84601-4427
Mailing Address265 E 200 SSalem, UT 84653-9452 · (801) 423-2373
Phone(801) 851-7026
Fax(801) 343-8725
Sole ProprietorNo
Enumeration DateNovember 27, 2006
Last NPPES UpdateJuly 9, 2007
✔ NPI 1629144308 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyRegistered Nurse · Community HealthNursing Service Providers
Taxonomy Code163WC1500X
License✔ Licensed in UT · 218040-3102
151 S UNIVERSITY AVE # 1900, Provo, UT 84601
Open in Google Maps ↗

Other Identifiers 6

Other103003506102UT · Select Health Provider #
Other55102UT · Pehp Provider #
OtherQM0000039389UT · Altius Provider#
Other73-00012UT · United Healthcare Id#
MedicaidPR00489UT
Medicaid998877660009UT

Other Providers at the Same Location NPPES 16

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

NEREIDA RODRIGUEZ RN
Registered Nurse (Community Health)
151 S UNIVERSITY AVE # 1900
PROVO, UT 84601
Utah County (801) 851-7090
MARLA RAFF RN
Registered Nurse (Community Health)
151 S UNIVERSITY AVE # 1900
PROVO, UT 84601
Utah County (801) 851-7059
SHARON B TOBLER RN
Registered Nurse (Community Health)
151 S UNIVERSITY AVE # 1900
PROVO, UT 84601
Utah County (801) 851-7020
LISA A HINCKLEY RN
Registered Nurse (Community Health)
151 S UNIVERSITY AVE # 1900
PROVO, UT 84601
Utah County (801) 851-7061
JENNIFER HATFIELD RN
Registered Nurse (Community Health)
151 S UNIVERSITY AVE # 1900
PROVO, UT 84601
Utah County (801) 851-7091
MARIANNE C LINDSEY RN
Registered Nurse (Community Health)
151 S UNIVERSITY AVE # 1900
PROVO, UT 84601
Utah County (801) 851-7067
LISA DORIUS RN
Registered Nurse (Community Health)
151 S UNIVERSITY AVE # 1900
PROVO, UT 84601
Utah County (801) 851-7047
MARLA J ADAMS RN
Registered Nurse (Community Health)
151 S UNIVERSITY AVE # 1900
PROVO, UT 84601
Utah County (801) 851-7033

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jackie Black's NPI number?

The NPI number for Jackie Black is 1629144308. It was assigned to this individual provider in the NPPES registry on November 27, 2006.

Where is Jackie Black located?

Jackie Black practices at 151 S University Ave # 1900, Provo, UT 84601. The listed phone number is (801) 851-7026.

What is Jackie Black's specialty?

The primary specialty registered for this NPI is Registered Nurse, specializing in Community Health, with taxonomy code 163WC1500X.

When was this NPI record last updated?

The NPPES record for Jackie Black was last updated on July 9, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 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.