Provider Demographics
NPI:1417690264
Name:MORGAN, TARA (FNP-C)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:MORGAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:795 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:WELCH
Mailing Address - State:WV
Mailing Address - Zip Code:24801-2341
Mailing Address - Country:US
Mailing Address - Phone:304-436-5420
Mailing Address - Fax:304-436-5036
Practice Address - Street 1:795 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:WELCH
Practice Address - State:WV
Practice Address - Zip Code:24801-2341
Practice Address - Country:US
Practice Address - Phone:304-436-5420
Practice Address - Fax:304-436-5036
Is Sole Proprietor?:No
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV111332363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily