Healthcare Provider Details

I. General information

NPI: 1649027061
Provider Name (Legal Business Name): MORGAN ALEXIS IDSO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2024
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 SIERRA ROSE DR STE 3
RENO NV
89511-2093
US

IV. Provider business mailing address

605 SIERRA ROSE DR STE 3
RENO NV
89511-2093
US

V. Phone/Fax

Practice location:
  • Phone: 775-689-5410
  • Fax: 775-689-5410
Mailing address:
  • Phone: 775-689-5410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA3430
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: