Healthcare Provider Details

I. General information

NPI: 1124984042
Provider Name (Legal Business Name): MORGAN AVANT BAKER FNP-APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 MAIN ST STE 200
CONWAY SC
29526-3567
US

IV. Provider business mailing address

PO BOX 73
CONWAY SC
29528-0073
US

V. Phone/Fax

Practice location:
  • Phone: 839-224-3701
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number31339
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: