Healthcare Provider Details

I. General information

NPI: 1487631461
Provider Name (Legal Business Name): LISA D MORGAN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 08/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 HALL ST
WIGGINS MS
39577-2110
US

IV. Provider business mailing address

415 S 28TH AVE
HATTIESBURG MS
39401-7246
US

V. Phone/Fax

Practice location:
  • Phone: 601-928-4412
  • Fax: 601-928-4792
Mailing address:
  • Phone: 601-928-4412
  • Fax: 601-579-5240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR763321
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR763321
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: