Provider Demographics
NPI:1881660520
Name:MORRISON, JODY M (APRN)
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:M
Last Name:MORRISON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:347 S LAURA ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67211-1518
Mailing Address - Country:US
Mailing Address - Phone:316-686-7117
Mailing Address - Fax:316-686-2679
Practice Address - Street 1:347 S LAURA ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67211
Practice Address - Country:US
Practice Address - Phone:131-668-6711
Practice Address - Fax:316-686-2679
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS44290363L00000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSS64711Medicare UPIN
KS100358160HMedicaid
KSS64711Medicare UPIN