Provider Demographics
NPI:1902824170
Name:MORRIS, JENNIFER S (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:S
Last Name:MORRIS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 771522
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38177-1522
Mailing Address - Country:US
Mailing Address - Phone:901-249-7668
Mailing Address - Fax:901-261-2542
Practice Address - Street 1:1601 NEW CASTLE RD
Practice Address - Street 2:
Practice Address - City:FORREST CITY
Practice Address - State:AR
Practice Address - Zip Code:72335-2218
Practice Address - Country:US
Practice Address - Phone:870-261-0513
Practice Address - Fax:870-261-0535
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2019-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC01532367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR157071001Medicaid
1902824170OtherTRICARE - SOUTH REGION
ARP01061008OtherRAILROAD MEDICARE
AR1902824170OtherBAPTIST HEALTH SERVICES GROUP, INC
AR5Y423OtherARKANSAS BLUE CROSS BLUE SHIELD
AR5V485C910Medicare PIN