Provider Demographics
NPI:1922735554
Name:MORGAN, CHRISTA JANE
Entity Type:Individual
Prefix:
First Name:CHRISTA
Middle Name:JANE
Last Name:MORGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 MELISSA CT
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:MO
Mailing Address - Zip Code:63084-2423
Mailing Address - Country:US
Mailing Address - Phone:636-259-0786
Mailing Address - Fax:
Practice Address - Street 1:300 MELISSA CT
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:MO
Practice Address - Zip Code:63084-2423
Practice Address - Country:US
Practice Address - Phone:636-259-0786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-03
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012023622363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOF07220223OtherAANP CERTIFICATION NUMBER