Healthcare Provider Details

I. General information

NPI: 1053082958
Provider Name (Legal Business Name): MIKELLA MORGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2021
Last Update Date: 09/22/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 GOODLETTE RD
NAPLES FL
34102-5614
US

IV. Provider business mailing address

670 GOODLETTE RD
NAPLES FL
34102-5614
US

V. Phone/Fax

Practice location:
  • Phone: 239-316-7656
  • Fax: 239-331-2581
Mailing address:
  • Phone: 239-316-7656
  • Fax: 239-331-2581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: