Provider Demographics
NPI:1609455104
Name:MORRISON, SAMANTHA YSENIA (NURSE PRACTITONER)
Entity Type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:YSENIA
Last Name:MORRISON
Suffix:
Gender:F
Credentials:NURSE PRACTITONER
Other - Prefix:MS
Other - First Name:SAMANTHA
Other - Middle Name:YSENIA
Other - Last Name:ESSELINGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NURSE PRACITIONER
Mailing Address - Street 1:16775 ADDISON RD STE 200
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-5654
Mailing Address - Country:US
Mailing Address - Phone:469-899-0759
Mailing Address - Fax:469-899-0759
Practice Address - Street 1:2315 E SOUTHLAKE BLVD STE 110
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6684
Practice Address - Country:US
Practice Address - Phone:817-902-9220
Practice Address - Fax:469-899-0759
Is Sole Proprietor?:No
Enumeration Date:2021-04-03
Last Update Date:2021-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1033654363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner