Healthcare Provider Details

I. General information

NPI: 1205120292
Provider Name (Legal Business Name): JENNIFER DAWN MORRIS HS-BCP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2011
Last Update Date: 02/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4016 SPY GLASS CIR
RIVERTON WY
82501-5433
US

IV. Provider business mailing address

1110 MAJOR AVE
RIVERTON WY
82501-2342
US

V. Phone/Fax

Practice location:
  • Phone: 307-857-5484
  • Fax:
Mailing address:
  • Phone: 307-856-6587
  • Fax: 307-856-2668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: