Healthcare Provider Details

I. General information

NPI: 1639689763
Provider Name (Legal Business Name): JOHN MICHAEL MORRIS APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2017
Last Update Date: 03/28/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 N CENTER ST
LONOKE AR
72086-2011
US

IV. Provider business mailing address

PO BOX 497
AUGUSTA AR
72006-0497
US

V. Phone/Fax

Practice location:
  • Phone: 501-676-0181
  • Fax: 501-676-0351
Mailing address:
  • Phone: 870-347-2534
  • Fax: 870-347-2023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA005377
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: