Healthcare Provider Details

I. General information

NPI: 1134845746
Provider Name (Legal Business Name): MORGAN WYRICK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2022
Last Update Date: 10/14/2022
Certification Date: 10/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9501 BAPTIST HEALTH DR STE 600
LITTLE ROCK AR
72205-6231
US

IV. Provider business mailing address

9501 BAPTIST HEALTH DR STE 600
LITTLE ROCK AR
72205-6231
US

V. Phone/Fax

Practice location:
  • Phone: 501-227-7596
  • Fax: 501-219-8633
Mailing address:
  • Phone:
  • Fax: 501-219-8633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-1114
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: