Provider Demographics
NPI:1558366963
Name:MORELOCK, LINDA S (FNPC)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:S
Last Name:MORELOCK
Suffix:
Gender:F
Credentials:FNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 850
Mailing Address - Street 2:
Mailing Address - City:ROGERSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37857-0850
Mailing Address - Country:US
Mailing Address - Phone:423-234-1020
Mailing Address - Fax:423-921-6920
Practice Address - Street 1:4307 HIGHWAY 66 S
Practice Address - Street 2:
Practice Address - City:ROGERSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37857-3155
Practice Address - Country:US
Practice Address - Phone:423-921-1600
Practice Address - Fax:423-921-1677
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6425363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3928392Medicaid
4081198OtherBCBST
3703869Medicare PIN
TN103I509748Medicare PIN
3928392Medicare PIN
3703865Medicare PIN
103I501714Medicare PIN
TN3928392Medicaid
4081198OtherBCBST