Jackie Evans Black is a Community Health Registered Nurse based in Salem, UT and is specialized in Community Health. Jackie Evans Black practices in Provo, UT and has the professional credentials of RN. The NPI Number for Jackie Evans Black is 1629144308 and holds a License No. 218040-3102 (Utah).
The current practice location address for Jackie Evans Black is 151 S University Ave # 1900, Provo, UT and can be reached out via phone at 801-851-7026 and via fax at 801-343-8725. You can also correspond with Jackie Evans Black through the mailing address at 265 E 200 S, SALEM, UT - 84653-9452 (mailing address contact number: 801-423-2373).
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 998877660009 | 05 | UT | |
| QM0000039389 | 01 | UT | ALTIUS PROVIDER# |
| 55102 | 01 | UT | PEHP PROVIDER # |
| 103003506102 | 01 | UT | SELECT HEALTH PROVIDER # |
| PR00489 | 05 | UT | |
| 73-00012 | 01 | UT | UNITED HEALTHCARE ID# |
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