Healthcare Provider Details

I. General information

NPI: 1386132074
Provider Name (Legal Business Name): MORGAN PAIGE AYCOCK HIS-T
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2018
Last Update Date: 04/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 JUSTICE ST
MONROE LA
71201-3620
US

IV. Provider business mailing address

2200 JUSTICE ST
MONROE LA
71201-3620
US

V. Phone/Fax

Practice location:
  • Phone: 318-325-2363
  • Fax:
Mailing address:
  • Phone: 318-325-2363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number1304
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: