Healthcare Provider Details

I. General information

NPI: 1619629664
Provider Name (Legal Business Name): HEATHER MICHELLE MORRIS CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2022
Last Update Date: 02/12/2025
Certification Date: 01/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11601 MONTGOMERY BLVD NE
ALBUQUERQUE NM
87111-2660
US

IV. Provider business mailing address

5704 BLUE PINE AVE NW
ALBUQUERQUE NM
87120-3303
US

V. Phone/Fax

Practice location:
  • Phone: 505-814-1995
  • Fax:
Mailing address:
  • Phone: 505-328-9334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number66707
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: