Healthcare Provider Details

I. General information

NPI: 1750412052
Provider Name (Legal Business Name): SUSAN GAIL MORRIS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 09/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 S NATIONAL AVE STE 301
SPRINGFIELD MO
65804
US

IV. Provider business mailing address

1911 S NATIONAL AVE STE 301
SPRINGFIELD MO
65804-2213
US

V. Phone/Fax

Practice location:
  • Phone: 417-725-8250
  • Fax: 417-724-3084
Mailing address:
  • Phone: 417-886-5000
  • Fax: 417-886-1100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberRN2002015397
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2002105397
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: