Healthcare Provider Details

I. General information

NPI: 1720462492
Provider Name (Legal Business Name): ANGELA MORRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2015
Last Update Date: 07/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6263 HIGHWAY 49 S
PARAGOULD AR
72450-6093
US

IV. Provider business mailing address

1101 W OAK AVE
JONESBORO AR
72401-3814
US

V. Phone/Fax

Practice location:
  • Phone: 870-240-0444
  • Fax: 870-240-0466
Mailing address:
  • Phone: 870-240-0444
  • Fax: 870-240-0466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: