Provider Demographics
NPI:1659756914
Name:MORTON, KELLIE BETH (FNP)
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:BETH
Last Name:MORTON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:831 S SAINT FRANCIS DR
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-3027
Mailing Address - Country:US
Mailing Address - Phone:505-501-7791
Mailing Address - Fax:505-501-7792
Practice Address - Street 1:831 S SAINT FRANCIS DR
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-3027
Practice Address - Country:US
Practice Address - Phone:505-501-7791
Practice Address - Fax:505-501-7792
Is Sole Proprietor?:No
Enumeration Date:2015-07-28
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2015023467363LF0000X
KS53-79107-092363LF0000X
NM72101363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily