MEDICARE: MCCALL JO MCMORRIS PMHNP-BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	10656371-4405	UT

General Provider Information

NPI Number	:	1467109074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MCCALL JO MCMORRIS PMHNP-BC

Provider Business Mailing Address
First Line	:	269 S 120 E
Second Line	:
City	:	IVINS
State	:	UT
Zip	:	84738-5090
Country	:	US
Telephone Number	:	972-890-4396
Fax Number	:

Provider Business Practice Location Address
First Line	:	145 N MALL DR UNIT 30
Second Line	:
City	:	ST GEORGE
State	:	UT
Zip	:	84790-8241
Country	:	US
Telephone Number	:	972-890-4396
Fax Number	:	855-480-9548

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

Provider Enumeration Date	:	03/03/2022
Last Update Date	:	01/22/2024

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