Healthcare Provider Details

I. General information

NPI: 1568843035
Provider Name (Legal Business Name): MICKINZIE RESHAE MORGAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2015
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4015 22ND PL
LUBBOCK TX
79410-1119
US

IV. Provider business mailing address

2215 NASHVILLE AVE
LUBBOCK TX
79410-1105
US

V. Phone/Fax

Practice location:
  • Phone: 806-725-0030
  • Fax:
Mailing address:
  • Phone: 806-725-5844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD.40417
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberMD.40417
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberS2124
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: