Healthcare Provider Details

I. General information

NPI: 1578296463
Provider Name (Legal Business Name): MORGAN ELIZABETH GARY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2022
Last Update Date: 01/09/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 CARTI WAY
LITTLE ROCK AR
72205-6523
US

IV. Provider business mailing address

281 PICKWICKET DR
CONWAY AR
72034-6181
US

V. Phone/Fax

Practice location:
  • Phone: 501-906-3000
  • Fax:
Mailing address:
  • Phone: 501-278-0108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPT2022-095
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: