MEDICARE: MORGAN HANNI PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AS0400X	Surgical Physician Assistant	2487	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	.	OTHER		PA-C

General Provider Information

NPI Number	:	1104216662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MORGAN HANNI PA-C

Provider Business Mailing Address
First Line	:	6600 N OLIE AVE STE C
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-7339
Country	:	US
Telephone Number	:	405-419-5665
Fax Number	:

Provider Business Practice Location Address
First Line	:	6600 N OLIE AVE STE C
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-7339
Country	:	US
Telephone Number	:	405-419-5665
Fax Number	:	405-419-5429

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/04/2015
Last Update Date	:	07/14/2021

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Directions to “ MORGAN HANNI PA-C” Practice Location

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