Provider Demographics
NPI:1598157026
Name:BESTENLEHNER, MORGAN (PA-C, ATC)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:
Last Name:BESTENLEHNER
Suffix:
Gender:F
Credentials:PA-C, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 BONNIE BLUE LN
Mailing Address - Street 2:
Mailing Address - City:WHITLEYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38588-7126
Mailing Address - Country:US
Mailing Address - Phone:129-408-6856
Mailing Address - Fax:
Practice Address - Street 1:110 IRVING ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-3017
Practice Address - Country:US
Practice Address - Phone:202-877-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-20
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X
IL096003594171W00000X
WI1445-39171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No171W00000XOther Service ProvidersContractor