Provider Demographics
NPI:1891770103
Name:MORRIS, KATHRYN DIANE (MSN, RN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:DIANE
Last Name:MORRIS
Suffix:
Gender:F
Credentials:MSN, RN, FNP-BC
Other - Prefix:
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Mailing Address - Street 1:PO BOX 310
Mailing Address - Street 2:
Mailing Address - City:SUMMERSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26651-0310
Mailing Address - Country:US
Mailing Address - Phone:304-872-7063
Mailing Address - Fax:304-872-7080
Practice Address - Street 1:400 FAIRVIEW HEIGHTS RD
Practice Address - Street 2:SUITE 302
Practice Address - City:SUMMERSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26651-9308
Practice Address - Country:US
Practice Address - Phone:304-872-7063
Practice Address - Fax:304-872-7080
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2014-03-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WV40555363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV7103076000Medicaid
WVNP23451Medicare PIN
S76735Medicare UPIN