Provider Demographics
NPI:1497731632
Name:MORRIS, TERESA (PA)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:MORRIS
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 1:4030 RIVER HILL DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78410-5606
Mailing Address - Country:US
Mailing Address - Phone:361-767-0303
Mailing Address - Fax:361-767-1220
Practice Address - Street 1:4030 RIVER HILL DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78410-5606
Practice Address - Country:US
Practice Address - Phone:361-767-0303
Practice Address - Fax:361-767-1220
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04618363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA04618OtherSTATE LICENSE
P25387Medicare UPIN