Provider Demographics
NPI:1811405004
Name:MORGAN, MARY KATHRYN (PA-C)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KATHRYN
Last Name:MORGAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:
Other - Last Name:MORGAN-KOCHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1670 FISHINGER RD STE 100
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-1446
Mailing Address - Country:US
Mailing Address - Phone:614-459-0077
Mailing Address - Fax:
Practice Address - Street 1:100 E CAMPUS VIEW BLVD STE 250
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-4682
Practice Address - Country:US
Practice Address - Phone:614-344-7547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-22
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.005406RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant