Healthcare Provider Details

I. General information

NPI: 1255531356
Provider Name (Legal Business Name): MORGAN F WHITE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2007
Last Update Date: 12/28/2022
Certification Date: 12/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3436 ISLETA BLVD SW
ALBUQUERQUE NM
87105-5837
US

IV. Provider business mailing address

PO BOX 2666 PHS PROVIDER ENROLLMENT
ALBUQEURQUE NM
87125-6666
US

V. Phone/Fax

Practice location:
  • Phone: 505-596-2300
  • Fax: 505-596-2380
Mailing address:
  • Phone: 505-923-6770
  • Fax: 850-494-9843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA 9107535
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1076461
License Number StateWV
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2022-0076
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: