Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Ivy Black, C-NP

Individual provider Family Nurse Practitioner · NPI 1104571462

Ivy Black, C-NP is a Nurse Practitioner in Kennesaw, Georgia. Qualified in 2018, 8 years ago. Practices with Minuteclinic LLC, a 574-clinician group and accepts Medicare assignment. Licensed in Georgia.

Years since qualifying
8
Licensed in
GA
In the registry since
2022

Practice location Address checks out

2782 Cobb Pkwy NW
Kennesaw, GA 30152-3472
Phone: (706) 405-1195
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence RN195496 (GA)

Record details

NPI number1104571462
Entity typeIndividual (Type 1)
GenderFemale
Credentials C-NP
Sole proprietorNo
NPI enumeratedFebruary 15, 2022
Last updated in NPPESJune 12, 2025
Certification dateJune 12, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2018 (8 years in practice)
Group practice Minuteclinic Llc — 574 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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