Healthcare Provider Details

I. General information

NPI: 1548099062
Provider Name (Legal Business Name): JACOB EARL MORRISON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2024
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 VALLEY WOOD RD
KANSAS OK
74347-9327
US

IV. Provider business mailing address

325 VALLEY WOOD RD
KANSAS OK
74347-9327
US

V. Phone/Fax

Practice location:
  • Phone: 479-228-0074
  • Fax:
Mailing address:
  • Phone: 479-228-0074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: