Healthcare Provider Details

I. General information

NPI: 1104245679
Provider Name (Legal Business Name): VALERIE W MORGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VALERIE ROBIN WADE

II. Dates (important events)

Enumeration Date: 04/14/2014
Last Update Date: 01/20/2021
Certification Date: 01/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4123 DUTCHMANS LANE SUITE 515
LOUISVILLE KY
40207-4714
US

IV. Provider business mailing address

PO BOX 776351
CHICAGO IL
60677-6351
US

V. Phone/Fax

Practice location:
  • Phone: 502-899-6907
  • Fax:
Mailing address:
  • Phone: 502-588-5490
  • Fax: 502-272-5116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3008213
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number1055724
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: