Healthcare Provider Details

I. General information

NPI: 1336788330
Provider Name (Legal Business Name): MORGAN LEA RUSSELL FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS MORGAN LEA TERRY

II. Dates (important events)

Enumeration Date: 12/23/2019
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 REGENT ST STE 200
COLUMBUS OH
43219-6229
US

IV. Provider business mailing address

906 BRENNA DR
SEYMOUR TN
37865-3337
US

V. Phone/Fax

Practice location:
  • Phone: 877-870-1775
  • Fax: 614-968-8840
Mailing address:
  • Phone: 865-659-1754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26710
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: