Provider Demographics
NPI:1295837904
Name:MORGAN, JACQUELINE MICHELLE (MD)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:MICHELLE
Last Name:MORGAN
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 1:3232 E MURDOCK ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-3003
Mailing Address - Country:US
Mailing Address - Phone:316-219-6777
Mailing Address - Fax:316-219-6778
Practice Address - Street 1:3232 E MURDOCK ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-3003
Practice Address - Country:US
Practice Address - Phone:316-219-6777
Practice Address - Fax:316-219-6778
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-34437207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200680090AMedicaid
KS200680090AMedicaid