Healthcare Provider Details

I. General information

NPI: 1316593122
Provider Name (Legal Business Name): MARKA MORGAN DAVIS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARKA MORGAN AHRENT

II. Dates (important events)

Enumeration Date: 08/16/2019
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 FULTON ST
BLYTHEVILLE AR
72315-1922
US

IV. Provider business mailing address

4600 GREGORY CV
JONESBORO AR
72405-7948
US

V. Phone/Fax

Practice location:
  • Phone: 844-215-0731
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number121695
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: