Provider Demographics
NPI:1740243385
Name:MORRIS, SCOTT KIMBERLY (PA-C)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:KIMBERLY
Last Name:MORRIS
Suffix:
Gender:M
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 1:4007 DIAMOND RUBY
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00820-4417
Mailing Address - Country:US
Mailing Address - Phone:340-513-0985
Mailing Address - Fax:
Practice Address - Street 1:4007 DIAMOND RUBY
Practice Address - Street 2:
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820-4417
Practice Address - Country:US
Practice Address - Phone:340-513-0985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA2885363A00000X
VI006363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORS56610Medicare UPIN