Provider Demographics
NPI:1093707077
Name:MORGAN, EDIE JAY (WHNP-BC, CNM, MS)
Entity Type:Individual
Prefix:MRS
First Name:EDIE
Middle Name:JAY
Last Name:MORGAN
Suffix:
Gender:F
Credentials:WHNP-BC, CNM, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1042 WILLOW CREEK RD
Mailing Address - Street 2:A101 #222
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-1673
Mailing Address - Country:US
Mailing Address - Phone:928-237-4422
Mailing Address - Fax:928-237-4421
Practice Address - Street 1:3105 CLEARWATER DR
Practice Address - Street 2:STE A
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-7166
Practice Address - Country:US
Practice Address - Phone:928-237-4422
Practice Address - Fax:928-237-4421
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN056003367A00000X
AZAPO-197363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ831041Medicaid
AZAZ0146110OtherBLUE CROSS/BLUE SHIELD
AZAZ0146110OtherBLUE CROSS/BLUE SHIELD
AZ77466Medicare PIN