Healthcare Provider Details

I. General information

NPI: 1174236392
Provider Name (Legal Business Name): MARKETIA MORROW FNP-BC, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2023
Last Update Date: 01/03/2023
Certification Date: 01/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1730 DORCHESTER DR
SOUTHAVEN MS
38671-5723
US

IV. Provider business mailing address

PO BOX 19599
BELFAST ME
04915-4090
US

V. Phone/Fax

Practice location:
  • Phone: 731-394-1145
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number905728
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: