Provider Demographics
NPI:1043576697
Name:MORSE, KRISTY A (MD)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:A
Last Name:MORSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 OLD WEST POINT RD
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-2604
Mailing Address - Country:US
Mailing Address - Phone:662-435-3568
Mailing Address - Fax:
Practice Address - Street 1:910 MADISON AVE
Practice Address - Street 2:SUITE 1031
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-3403
Practice Address - Country:US
Practice Address - Phone:901-448-5364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-09
Last Update Date:2017-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TN53008208000000X, 2080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No208000000XAllopathic & Osteopathic PhysiciansPediatrics