Provider Demographics
NPI:1467922583
Name:MORRIS, MONICA DENEE
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:DENEE
Last Name:MORRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3198 MILDRED DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40216-4921
Mailing Address - Country:US
Mailing Address - Phone:502-533-9675
Mailing Address - Fax:
Practice Address - Street 1:3198 MILDRED DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-4921
Practice Address - Country:US
Practice Address - Phone:502-533-9675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-01
Last Update Date:2018-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver