Provider Demographics
NPI:1174503742
Name:MORGAN, KEITH LEILAN (ADULT NURSE PRACTITI)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:LEILAN
Last Name:MORGAN
Suffix:
Gender:M
Credentials:ADULT NURSE PRACTITI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16302 ROSS OAK ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-1333
Mailing Address - Country:US
Mailing Address - Phone:908-309-9506
Mailing Address - Fax:
Practice Address - Street 1:16302 ROSS OAK ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-1333
Practice Address - Country:US
Practice Address - Phone:210-595-8614
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP003367C363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health