Healthcare Provider Details

I. General information

NPI: 1356380414
Provider Name (Legal Business Name): HEATHER MORRIS WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 S 12TH AVE
LAUREL MS
39440-4324
US

IV. Provider business mailing address

PO BOX 2038
LAUREL MS
39442-2038
US

V. Phone/Fax

Practice location:
  • Phone: 601-649-9904
  • Fax: 601-649-9903
Mailing address:
  • Phone: 601-649-9904
  • Fax: 601-649-9903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberR854299
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: