KELLY BLACK PMHNP-BC
NPI 1912653536
Nurse Practitioner - Psychiatric/Mental Health in Mesa, AZ

Q: What is Kelly Black's NPI number?

The NPI number for Kelly Black is 1912653536. It was assigned to this individual provider in the NPPES registry on February 22, 2022.

Q: What is Kelly Black's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

Q: When was this NPI record last updated?

The NPPES record for Kelly Black was last updated on February 6, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 months 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 February 22, 2022PECOS Enrolled

1910 S STAPLEY DR STE 120, MESA, AZ 85204(602) 341-3303 Get Directions Write a Review

NPPES record last updated: February 6, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Feb 6, 2025, Feb 22, 2022 (2 updates tracked since 2022).

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About Kelly Black Pmhnp-bc NPPES

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

KELLY BLACK PMHNP-BC (NPI 1912653536) is an individual psychiatric/mental health provider in Mesa, Arizona, licensed in California (95024873) and active in the NPI registry since February 2022. She is enrolled in Medicare PECOS and maintains a secondary practice location in Homeland.

NPPES Registry Identity

NPI1912653536

Entity TypeIndividualFemale

Primary Taxonomy363LP0808X

Provider Legal NameKELLY BLACKCredential: PMHNP-BC

Location Address1910 S STAPLEY DR STE 120Mesa, AZ 85204-6676

Mailing Address1910 S Stapley Dr Ste 120Mesa, AZ 85204-6676 · (951) 623-7194

Phone(602) 341-3303

Sole ProprietorNo

Enumeration DateFebruary 22, 2022

Last NPPES UpdateFebruary 6, 20252 updates tracked since enumeration

NPPES CertifiedFebruary 6, 2025

✔ NPI 1912653536 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LP0808X

Licenses✔ Licensed in CA · 95024873✔ Licensed in AZ · 305924

Also ListedRegistered Nurse · Psychiatric/Mental HealthTaxonomy 163WP0808X · License 56220 (CA)

1910 S STAPLEY DR STE 120, Mesa, AZ 85204

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Secondary Practice Location 1

Location 132205 Snyder LnHomeland, CA 92548-9600 · Phone (951) 623-7194

Other Identifiers 1

Other305924AZ · Arizona Board Of Nursing Certified Nurse Practitioner License Pmhnp-bc

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kelly Black Pmhnp-bc 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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 85204 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$85.89 typical visit price

range $55.44 – $168.60

Typical copayment $21.47 (range $13.86 – $42.15)

Most-billed visit code 99203

Established Patient

$98.00 typical visit price

range $17.72 – $137.41

Typical copayment $24.50 (range $4.43 – $34.35)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

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

EVOLVE HEALTH AND WEIGHT SOLUTIONS PLLC

Physician Assistant (Medical)