=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598254518
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TERRICA MORGAN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/04/2018
-----------------------------------------------------
Last Update Date | 05/04/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4300 W 7TH ST
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72205-5446
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-257-1000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1902 PLEASANT POINTE CIR
-----------------------------------------------------
City | BRYANT
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72022-3933
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-350-6464
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2471C1101X
-----------------------------------------------------
Taxonomy Name | Cardiovascular-Interventional Technology Radiologic Technologist
-----------------------------------------------------
License Number | 521196
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------