Healthcare Provider Details

I. General information

NPI: 1083152821
Provider Name (Legal Business Name): CHEYENNE MORGAN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2017
Last Update Date: 11/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 VIRGINIA DR STE C
BATESVILLE AR
72501-7317
US

IV. Provider business mailing address

501 VIRGINIA DR STE. C
BATESVILLE AR
72501
US

V. Phone/Fax

Practice location:
  • Phone: 870-793-2371
  • Fax:
Mailing address:
  • Phone: 870-793-2371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPT2017-007
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: