Healthcare Provider Details

I. General information

NPI: 1265032825
Provider Name (Legal Business Name): MORGAN ROSE GRANTHAM APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2020
Last Update Date: 10/31/2020
Certification Date: 10/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ROSE ST
LEXINGTON KY
40536-7001
US

IV. Provider business mailing address

619 GINGERMILL LN
LEXINGTON KY
40509-1917
US

V. Phone/Fax

Practice location:
  • Phone: 860-944-4971
  • Fax:
Mailing address:
  • Phone: 860-944-4971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License Number3013509
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: