Healthcare Provider Details

I. General information

NPI: 1508596826
Provider Name (Legal Business Name): MORGAN ROARK CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2022
Last Update Date: 06/25/2024
Certification Date: 05/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 HARPER RD
BECKLEY WV
25801-3397
US

IV. Provider business mailing address

55 ABIGAIL LN
FAYETTEVILLE WV
25840-5362
US

V. Phone/Fax

Practice location:
  • Phone: 304-256-4100
  • Fax:
Mailing address:
  • Phone: 304-731-5206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number92107
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number119371
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: