Healthcare Provider Details

I. General information

NPI: 1306293436
Provider Name (Legal Business Name): MORGAN O'NEAL AGACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MORGAN MARTIN

II. Dates (important events)

Enumeration Date: 05/18/2016
Last Update Date: 05/01/2023
Certification Date: 05/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 GRAMMONT ST.
MONROE LA
71201-7516
US

IV. Provider business mailing address

611 GRAMMONT ST.
MONROE LA
71201-7516
US

V. Phone/Fax

Practice location:
  • Phone: 318-325-2649
  • Fax: 318-388-4177
Mailing address:
  • Phone: 318-325-2649
  • Fax: 318-388-4177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN132816
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP08925
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: