MEDICARE: MS. KEYELLIA M MORRIES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1013592484
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KEYELLIA M MORRIES

Provider Business Mailing Address
First Line	:	PO BOX 1774
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53201-1774
Country	:	US
Telephone Number	:	414-324-8473
Fax Number	:

Provider Business Practice Location Address
First Line	:	4159 N 60TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-1268
Country	:	US
Telephone Number	:	414-324-8473
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2021
Last Update Date	:	07/10/2025

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