Provider Demographics
NPI:1598847303
Name:MORGAN, CONNIE MARIE (NP)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:MARIE
Last Name:MORGAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-2843
Mailing Address - Country:US
Mailing Address - Phone:606-327-5044
Mailing Address - Fax:606-327-7425
Practice Address - Street 1:419 VERNON ST
Practice Address - Street 2:
Practice Address - City:IRONTON
Practice Address - State:OH
Practice Address - Zip Code:45638-1637
Practice Address - Country:US
Practice Address - Phone:740-534-0021
Practice Address - Fax:740-534-0029
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV0390472363LF0000X
OHNP09029363LF0000X
KY43068363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q40482Medicare UPIN