Provider Demographics
NPI:1366034845
Name:MORGNER, KATELYN MARIE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:KATELYN
Middle Name:MARIE
Last Name:MORGNER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2065 SOUTH CENTER RD
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48519-3540
Mailing Address - Country:US
Mailing Address - Phone:810-235-2004
Mailing Address - Fax:
Practice Address - Street 1:2065 S. CENTER ROAD
Practice Address - Street 2:
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48519
Practice Address - Country:US
Practice Address - Phone:810-235-2004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-06
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704304274163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse