Healthcare Provider Details

I. General information

NPI: 1235770942
Provider Name (Legal Business Name): VINCENT TYRONE MORGAN APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2019
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 W 12TH ST
LITTLE ROCK AR
72204-1716
US

IV. Provider business mailing address

PO BOX 746873
ATLANTA GA
30374-6873
US

V. Phone/Fax

Practice location:
  • Phone: 501-435-1402
  • Fax:
Mailing address:
  • Phone: 773-352-1515
  • Fax: 312-929-0373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP143904
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License NumberAP143904
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number122297
License Number StateAR
# 4
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number122297
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: