Provider Demographics
NPI:1619010253
Name:MORSE, KRISTA R (DPH)
Entity Type:Individual
Prefix:MS
First Name:KRISTA
Middle Name:R
Last Name:MORSE
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 ORCHARD ST
Mailing Address - Street 2:
Mailing Address - City:GLEASON
Mailing Address - State:TN
Mailing Address - Zip Code:38229-7234
Mailing Address - Country:US
Mailing Address - Phone:731-648-9551
Mailing Address - Fax:731-648-5524
Practice Address - Street 1:102 MAIN ST
Practice Address - Street 2:
Practice Address - City:GLEASON
Practice Address - State:TN
Practice Address - Zip Code:38229-7268
Practice Address - Country:US
Practice Address - Phone:731-648-5146
Practice Address - Fax:731-648-5524
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5352183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist