Healthcare Provider Details

I. General information

NPI: 1447274568
Provider Name (Legal Business Name): KIM MARIE MORGAN RNC, MSN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WYOMING ST
DAYTON OH
45409-2722
US

IV. Provider business mailing address

7861 COURT RIDGE LN
FAIRBORN OH
45324-1881
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-3641
  • Fax:
Mailing address:
  • Phone: 937-864-2852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberNP-08348
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: