Healthcare Provider Details

I. General information

NPI: 1053119396
Provider Name (Legal Business Name): EVELYN MARIE MORTON N/A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: EVELYN MARIE MORTON N/A

II. Dates (important events)

Enumeration Date: 03/04/2025
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2197 VERSAILLES ROAD
LEXINGTON KY
40504
US

IV. Provider business mailing address

1551 ARISTIDES BLVD APT. 1421
LEXINGTON KY
40511-1674
US

V. Phone/Fax

Practice location:
  • Phone: 859-979-6120
  • Fax:
Mailing address:
  • Phone: 859-979-6120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: