Healthcare Provider Details

I. General information

NPI: 1831644350
Provider Name (Legal Business Name): ANDREW MORRIS ACNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2016
Last Update Date: 11/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2470 FLOWOOD DR
JACKSON MS
39232-9019
US

IV. Provider business mailing address

2470 FLOWOOD DR
FLOWOOD MS
39232-9019
US

V. Phone/Fax

Practice location:
  • Phone: 601-983-2781
  • Fax: 601-983-2791
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number904584
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number904584
License Number StateMS
# 3
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number901824
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: