Healthcare Provider Details

I. General information

NPI: 1124620455
Provider Name (Legal Business Name): MORGAN R MOCKBEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MORGAN R DALL

II. Dates (important events)

Enumeration Date: 11/11/2020
Last Update Date: 04/09/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 N MERIDIAN ST
INDIANAPOLIS IN
46202-1403
US

IV. Provider business mailing address

1725 N MERIDIAN ST
INDIANAPOLIS IN
46202-1403
US

V. Phone/Fax

Practice location:
  • Phone: 317-396-2679
  • Fax:
Mailing address:
  • Phone: 317-396-2679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10003224A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: