Healthcare Provider Details

I. General information

NPI: 1376756080
Provider Name (Legal Business Name): FANTA VAUGHN MORGAN-KITSON D.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 02/17/2020
Certification Date: 02/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 OLD RUDNICK LN
DOVER DE
19901-4912
US

IV. Provider business mailing address

22 OLD RUDNICK LN
DOVER DE
19901-4912
US

V. Phone/Fax

Practice location:
  • Phone: 302-674-9255
  • Fax: 302-674-9096
Mailing address:
  • Phone: 302-674-9255
  • Fax: 302-674-9096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC005937
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE1-0000188
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: