MEDICARE: MRS. LACEY MORGAN FNP-C

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	363LG0600X	Gerontology Nurse Practitioner	APRN.CNP.0029758	OH

General Provider Information

NPI Number	:	1083385603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LACEY MORGAN FNP-C

Provider Business Mailing Address
First Line	:	1219 3RD ST
Second Line	:
City	:	MOUNDSVILLE
State	:	WV
Zip	:	26041-1651
Country	:	US
Telephone Number	:	304-238-8490
Fax Number	:

Provider Business Practice Location Address
First Line	:	2200 FLORAL ST
Second Line	:
City	:	MOUNDSVILLE
State	:	WV
Zip	:	26041-1293
Country	:	US
Telephone Number	:	304-843-1035
Fax Number	:

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

Provider Enumeration Date	:	09/23/2021
Last Update Date	:	09/23/2021

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