Provider Demographics
NPI:1295915593
Name:MORGAN, TAMMARA CREASON (MSN)
Entity type:Individual
Prefix:MRS
First Name:TAMMARA
Middle Name:CREASON
Last Name:MORGAN
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 COUNTY ROAD 713
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-7308
Mailing Address - Country:US
Mailing Address - Phone:662-808-2429
Mailing Address - Fax:
Practice Address - Street 1:88 COUNTY ROAD 713
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-7308
Practice Address - Country:US
Practice Address - Phone:662-808-2429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS00770369372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00770369Medicaid