Healthcare Provider Details

I. General information

NPI: 1447487624
Provider Name (Legal Business Name): JESSICA LYNN MORRIS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2009
Last Update Date: 11/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1285 FRANCISCAN DR
LITCHFIELD IL
62056-1778
US

IV. Provider business mailing address

101 UNITED DR
COLLINSVILLE IL
62234-7428
US

V. Phone/Fax

Practice location:
  • Phone: 217-324-6127
  • Fax: 217-324-5959
Mailing address:
  • Phone: 618-344-3113
  • Fax: 618-344-0957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: