Provider Demographics
NPI:1689238453
Name:MORRIS, KATHERYN CARMICHAEL (NP-C)
Entity Type:Individual
Prefix:
First Name:KATHERYN
Middle Name:CARMICHAEL
Last Name:MORRIS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:KATHERYN
Other - Middle Name:MCCALL
Other - Last Name:CARMICHAEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1821 E HIGH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45505-1225
Mailing Address - Country:US
Mailing Address - Phone:937-323-7340
Mailing Address - Fax:
Practice Address - Street 1:1821 E HIGH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45505-1225
Practice Address - Country:US
Practice Address - Phone:937-323-7340
Practice Address - Fax:937-323-3363
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-27
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-159833163W00000X
TX1105885363L00000X
OHCNP.0027375363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2210400468OtherCARESOURCE
OH0479977Medicaid
OH0000001638056OtherANTHEM