MEDICARE: KELLIE BETH MORTON FNP

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	363LF0000X	Family Nurse Practitioner	2015023467	MO
2	363LF0000X	Family Nurse Practitioner	53-79107-092	KS
3	363LF0000X	Family Nurse Practitioner	72101	NM

General Provider Information

NPI Number	:	1659756914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLIE BETH MORTON FNP

Provider Business Mailing Address
First Line	:	831 S SAINT FRANCIS DR
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-3027
Country	:	US
Telephone Number	:	505-501-7791
Fax Number	:	505-501-7792

Provider Business Practice Location Address
First Line	:	831 S SAINT FRANCIS DR
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-3027
Country	:	US
Telephone Number	:	505-501-7791
Fax Number	:	505-501-7792

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

Provider Enumeration Date	:	07/28/2015
Last Update Date	:	10/19/2023

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