Healthcare Provider Details

I. General information

NPI: 1215364674
Provider Name (Legal Business Name): NATHAN DEVEARL MORGAN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2013
Last Update Date: 05/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6460 MEDICAL CENTER ST STE 350
LAS VEGAS NV
89148-2423
US

IV. Provider business mailing address

111 N NAPPANEE ST
ELKHART IN
46514-1957
US

V. Phone/Fax

Practice location:
  • Phone: 702-255-6647
  • Fax: 702-933-1444
Mailing address:
  • Phone: 574-522-0265
  • Fax: 574-293-2855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10001466A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: