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: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W CAPITOL AVE STE 1700
LITTLE ROCK AR
72201-3438
US

IV. Provider business mailing address

13900 RIVERPORT DR
MARYLAND HEIGHTS MO
63043-4804
US

V. Phone/Fax

Practice location:
  • Phone: 855-964-0576
  • Fax: 501-387-1139
Mailing address:
  • Phone: 855-229-2191
  • Fax: 501-387-1139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: