Provider Demographics
NPI:1205053279
Name:JENNIFER M MORRIS, PA-C, PLC
Entity type:Organization
Organization Name:JENNIFER M MORRIS, PA-C, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:M
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:928-380-7600
Mailing Address - Street 1:121 W GNEISS TRL
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-8382
Mailing Address - Country:US
Mailing Address - Phone:928-380-7600
Mailing Address - Fax:
Practice Address - Street 1:121 W GNEISS TRL
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-8382
Practice Address - Country:US
Practice Address - Phone:928-380-7600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2745363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ746737Medicare ID - Type UnspecifiedJENNIFER M MORRIS, PA-C
AZP80090Medicare UPIN