Provider Demographics
NPI:1699404814
Name:MOELTER, MORGAN LYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:LYNN
Last Name:MOELTER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 S PARKVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:SD
Mailing Address - Zip Code:57005-1937
Mailing Address - Country:US
Mailing Address - Phone:605-731-9634
Mailing Address - Fax:
Practice Address - Street 1:110 N 175TH ST STE 1000
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68118-3581
Practice Address - Country:US
Practice Address - Phone:402-955-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-06
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3020363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant