Healthcare Provider Details

I. General information

NPI: 1700306404
Provider Name (Legal Business Name): STEPHANIE KAY MORRIS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2017
Last Update Date: 06/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E VAUGHN AVE
RUSTON LA
71270-5950
US

IV. Provider business mailing address

200 CORPORATE BLVD
LAFAYETTE LA
70508-3870
US

V. Phone/Fax

Practice location:
  • Phone: 318-254-2100
  • Fax: 318-254-2728
Mailing address:
  • Phone: 800-701-3381
  • Fax: 231-922-4030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP09382
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: