Healthcare Provider Details

I. General information

NPI: 1922948009
Provider Name (Legal Business Name): MORGAN TAYLOR HICKINGBOTTOM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12517 W GRANT ST
AVONDALE AZ
85323-8465
US

IV. Provider business mailing address

12517 W GRANT ST
AVONDALE AZ
85323-8465
US

V. Phone/Fax

Practice location:
  • Phone: 623-257-4339
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: