Provider Demographics
NPI:1851566871
Name:MORGAN, KIRSTIN MARIE (MS, CRC)
Entity Type:Individual
Prefix:
First Name:KIRSTIN
Middle Name:MARIE
Last Name:MORGAN
Suffix:
Gender:F
Credentials:MS, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1918 N BIRCH AVE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-2408
Mailing Address - Country:US
Mailing Address - Phone:479-442-5600
Mailing Address - Fax:479-442-5192
Practice Address - Street 1:1918 N BIRCH AVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-2408
Practice Address - Country:US
Practice Address - Phone:479-442-5600
Practice Address - Fax:479-442-5192
Is Sole Proprietor?:No
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR905010446171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR905010446Medicaid