Provider Demographics
NPI:1518076140
Name:MORRISON, TIMOTHY LAWRENCE (FNP)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:LAWRENCE
Last Name:MORRISON
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4795 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77707-3810
Mailing Address - Country:US
Mailing Address - Phone:409-656-6400
Mailing Address - Fax:
Practice Address - Street 1:4795 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77707-3810
Practice Address - Country:US
Practice Address - Phone:409-656-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007955363LF0000X
TX662034363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50065635OtherPASSPORT
KYK124530Medicare PIN