Provider Demographics
NPI:1336788330
Name:RUSSELL, MORGAN LEA (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:MORGAN
Middle Name:LEA
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MISS
Other - First Name:MORGAN
Other - Middle Name:LEA
Other - Last Name:TERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1364 MARTIN MILL PIKE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:TN
Mailing Address - Zip Code:37853-3604
Mailing Address - Country:US
Mailing Address - Phone:865-659-1754
Mailing Address - Fax:
Practice Address - Street 1:470 COLLIER DR
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-6931
Practice Address - Country:US
Practice Address - Phone:865-286-5421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-23
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26710363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily