Healthcare Provider Details

I. General information

NPI: 1144653411
Provider Name (Legal Business Name): ERIN MARIE MORRISSEY PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2013
Last Update Date: 03/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 N MORLEY ST SUITE A120A
MOBERLY MO
65270-3666
US

IV. Provider business mailing address

PO BOX 295
KIRKSVILLE MO
63501-0295
US

V. Phone/Fax

Practice location:
  • Phone: 660-372-9595
  • Fax:
Mailing address:
  • Phone: 660-665-7575
  • Fax: 660-665-7576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number3197
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: