Healthcare Provider Details

I. General information

NPI: 1093707077
Provider Name (Legal Business Name): EDIE JAY MORGAN WHNP-BC, CNM, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 07/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3105 CLEARWATER DR STE A
PRESCOTT AZ
86305-7166
US

IV. Provider business mailing address

1042 WILLOW CREEK RD A101 #222
PRESCOTT AZ
86301-1673
US

V. Phone/Fax

Practice location:
  • Phone: 928-237-4422
  • Fax: 928-237-4421
Mailing address:
  • Phone: 928-237-4422
  • Fax: 928-237-4421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberRN056003
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAPO-197
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: