Healthcare Provider Details

I. General information

NPI: 1104561711
Provider Name (Legal Business Name): MORGAN BEARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2022
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 N CLINTON ST
FORT WAYNE IN
46825-5886
US

IV. Provider business mailing address

5050 N CLINTON ST
FORT WAYNE IN
46825-5886
US

V. Phone/Fax

Practice location:
  • Phone: 260-484-8551
  • Fax: 260-482-5060
Mailing address:
  • Phone: 260-484-8551
  • Fax: 260-482-5060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71012623A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number28243442A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: