Provider Demographics
NPI:1518686112
Name:MORSE, JENNIFER GWEN
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:GWEN
Last Name:MORSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:FUCHS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:113 PEGGY DR
Mailing Address - Street 2:
Mailing Address - City:ELK CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73644-1221
Mailing Address - Country:US
Mailing Address - Phone:580-799-2763
Mailing Address - Fax:
Practice Address - Street 1:3216 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ALTUS
Practice Address - State:OK
Practice Address - Zip Code:73521-1307
Practice Address - Country:US
Practice Address - Phone:580-379-9090
Practice Address - Fax:580-379-9091
Is Sole Proprietor?:No
Enumeration Date:2022-08-25
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK209960363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK201135330AMedicaid