Provider Demographics
NPI:1396388062
Name:BECKWITH, MORGAN TAYLOR (PA)
Entity Type:Individual
Prefix:MS
First Name:MORGAN
Middle Name:TAYLOR
Last Name:BECKWITH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2128 SENITA DR
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5756
Mailing Address - Country:US
Mailing Address - Phone:928-208-9028
Mailing Address - Fax:
Practice Address - Street 1:2128 SENITA DR
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5756
Practice Address - Country:US
Practice Address - Phone:928-208-9028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-24
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7730363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical