Healthcare Provider Details

I. General information

NPI: 1205328366
Provider Name (Legal Business Name): MORGAN R CUNNINGHAM PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2018
Last Update Date: 09/11/2021
Certification Date: 09/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14600 SW MURRAY SCHOLLS DR
BEAVERTON OR
97007-9712
US

IV. Provider business mailing address

PO BOX 3229
PORTLAND OR
97208-3229
US

V. Phone/Fax

Practice location:
  • Phone: 888-227-3312
  • Fax:
Mailing address:
  • Phone: 888-227-3312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA195627
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: