Healthcare Provider Details

I. General information

NPI: 1053010819
Provider Name (Legal Business Name): OWAIRNA L MORRIS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2023
Last Update Date: 11/29/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3445 POPLAR AVE
MEMPHIS TN
38111-4667
US

IV. Provider business mailing address

PO BOX 1128
OLIVE BRANCH MS
38654-0940
US

V. Phone/Fax

Practice location:
  • Phone: 901-417-6551
  • Fax:
Mailing address:
  • Phone: 901-619-1557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0300X
TaxonomyNephrology Registered Nurse
License Number868631
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number905902
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number33682
License Number StateTN
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number33682
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: