Provider Demographics
NPI:1871503987
Name:MORSE, KATHY BAXENDALE (APRN OR PNP)
Entity Type:Individual
Prefix:MS
First Name:KATHY
Middle Name:BAXENDALE
Last Name:MORSE
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Gender:F
Credentials:APRN OR PNP
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Mailing Address - Street 1:1485 JESSE JEWEL PARKWAY, SUITE 200
Mailing Address - Street 2:PEDIATRIC ASSOCIATES
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501
Mailing Address - Country:US
Mailing Address - Phone:770-534-5255
Mailing Address - Fax:770-287-3871
Practice Address - Street 1:2695 OLD WINDER HWY, SUITE 200
Practice Address - Street 2:PEDIATRIC ASSOCIATES
Practice Address - City:BRASELTON
Practice Address - State:GA
Practice Address - Zip Code:30517
Practice Address - Country:US
Practice Address - Phone:770-965-6894
Practice Address - Fax:770-287-3871
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CARN426822363L00000X, 363LP0200X
GARN208550363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN426822Medicaid
CARN426822Medicaid
CAP44404Medicare UPIN