Provider Demographics
NPI:1063485480
Name:MORROW, BRYNETTA (PAC)
Entity Type:Individual
Prefix:
First Name:BRYNETTA
Middle Name:
Last Name:MORROW
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15645
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89114-5645
Mailing Address - Country:US
Mailing Address - Phone:702-750-3425
Mailing Address - Fax:702-750-3434
Practice Address - Street 1:8680 W CHEYENNE AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-7458
Practice Address - Country:US
Practice Address - Phone:702-750-3425
Practice Address - Fax:702-750-3434
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA935363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1063485480Medicaid
NV100508176Medicaid
NVFO706ZMedicare PIN
NVQ62236Medicare UPIN
NV101951Medicare PIN
NV100508176Medicaid