Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 71001867A | IN |
N | 363LC1500X | Nurse Practitioner - Community Health | 71001867A | IN |
Y | 363LW0102X | Nurse Practitioner - Women's Health | 71001867A | IN |
NPI | 1104808005 |
---|---|
Provider Name | Kristi A Morris |
First Address | Fort Wayne, IN 46845-1701 |
Second Address | Garrett, IN 46738-1138 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2005 |
Last Update Date | 21/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200511230 | (05) | IN |
Q38083 | (02) | IN |