Provider Demographics
NPI:1285612994
Name:MORRIS, COLLEEN ANNETTE (MD)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:ANNETTE
Last Name:MORRIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1701 W CHARLESTON BLVD
Mailing Address - Street 2:215
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-2325
Mailing Address - Country:US
Mailing Address - Phone:702-992-6868
Mailing Address - Fax:702-992-6860
Practice Address - Street 1:3006 S MARYLAND PKWY
Practice Address - Street 2:315
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-2218
Practice Address - Country:US
Practice Address - Phone:702-992-6868
Practice Address - Fax:702-992-6860
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV5452207SG0201X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002019982Medicaid
NV002002570Medicaid
NEG42205OtherUPIN
NECS04870OtherSTATE PHARMACY
NECS04870OtherSTATE PHARMACY
NV002002570Medicaid