Provider Demographics
NPI:1477374072
Name:MORRIS, KEIYANA (PA)
Entity type:Individual
Prefix:
First Name:KEIYANA
Middle Name:
Last Name:MORRIS
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3672 W IMPERIAL HWY APT 309
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90303-3051
Mailing Address - Country:US
Mailing Address - Phone:954-940-2298
Mailing Address - Fax:
Practice Address - Street 1:3672 W IMPERIAL HWY APT 309
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90303-3051
Practice Address - Country:US
Practice Address - Phone:954-940-2298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-17
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA66146363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant