Ivy Black, C-NP
NPI 1104571462ActiveIndividual· Nurse Practitioner, Family· Kennesaw, GA
Nurse Practitioner, Family (C-NP) with Minuteclinic LLC, practicing in Kennesaw, Georgia. Enrolled in Medicare as practitioner - nurse practitioner.
Overview
| NPI | 1104571462 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | C-NP |
| Sole proprietor | No |
| NPI issued | Feb 15, 2022 |
| Last updated in NPPES | Jun 12, 2025 |
| Certified by provider | Jun 12, 2025 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Nurse Practitioner, Family Primary | 363LF0000X | RN195496 | GA |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Nurse Practitioner (GA) |
|---|
Education and affiliations
| Graduation year | 2018 |
|---|---|
| Medicare specialty | Nurse Practitioner |
Medical group
- Minuteclinic LLCJacksonville, FL · 577 clinicians
Industry payments (Open Payments)
None reported for 2025 or 2024.
Receiving payments does not imply wrongdoing. What Open Payments covers ·original records
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All 97 family nurse practitioners in Kennesaw · All family nurse practitioners in Georgia