Provider Demographics
NPI:1316534597
Name:MORGAN, MICAH (PA-C)
Entity Type:Individual
Prefix:
First Name:MICAH
Middle Name:
Last Name:MORGAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11311 BRIDGEPORT WAY SW STE 100
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-3096
Mailing Address - Country:US
Mailing Address - Phone:253-985-2949
Mailing Address - Fax:253-985-2948
Practice Address - Street 1:11311 BRIDGEPORT WAY SW STE 100
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-3096
Practice Address - Country:US
Practice Address - Phone:253-985-2949
Practice Address - Fax:253-985-2948
Is Sole Proprietor?:No
Enumeration Date:2020-12-22
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC5-0011606363A00000X
WAPA61413217363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2254732Medicaid