Provider Demographics
NPI:1619396132
Name:MORRIS, KATHERINE OLIVIA (CPNP)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:OLIVIA
Last Name:MORRIS
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:MS
Other - First Name:KATHERINE
Other - Middle Name:OLIVIA
Other - Last Name:TATE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3497 DULUTH PARK LANE NW
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096
Mailing Address - Country:US
Mailing Address - Phone:770-813-9775
Mailing Address - Fax:770-813-8976
Practice Address - Street 1:3497 DULUTH PARK LANE NW
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096
Practice Address - Country:US
Practice Address - Phone:770-813-9775
Practice Address - Fax:770-813-8976
Is Sole Proprietor?:No
Enumeration Date:2014-04-11
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN191040363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics