Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 0024181611 | VA |
NPI | 1003485699 |
---|---|
Provider Name | Ieachia T. Morris |
First Address | Roanoke, VA 24015-3929 |
Second Address | Roanoke, VA 24015-3929 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2021 |
Last Update Date | 18/06/2021 |