Provider Demographics
NPI:1568826022
Name:SMITH, MORGAN SHEA
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:SHEA
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:MORGAN
Other - Middle Name:SHEA
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:9100 W 74TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66204-4004
Mailing Address - Country:US
Mailing Address - Phone:913-297-1991
Mailing Address - Fax:843-692-1122
Practice Address - Street 1:9100 W 74TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66204-4004
Practice Address - Country:US
Practice Address - Phone:913-297-1991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-11
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0542929207P00000X
390200000X
MO2020030340207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program