Provider Demographics
NPI:1669962908
Name:MORRIS, TANYA MARIE (PNP)
Entity type:Individual
Prefix:MS
First Name:TANYA
Middle Name:MARIE
Last Name:MORRIS
Suffix:
Gender:F
Credentials:PNP
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Mailing Address - Street 1:1 CHILDRENS PL
Mailing Address - Street 2:MSC 8515-87-1200
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1002
Mailing Address - Country:US
Mailing Address - Phone:314-454-2644
Mailing Address - Fax:314-454-2110
Practice Address - Street 1:1 CHILDRENS PL
Practice Address - Street 2:DIV PED EMERGENCY MED
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1002
Practice Address - Country:US
Practice Address - Phone:314-454-2341
Practice Address - Fax:314-454-4345
Is Sole Proprietor?:No
Enumeration Date:2018-05-11
Last Update Date:2022-10-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2018007970363LP0200X, 363LP0222X
IL209.019518363LP0222X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420058351Medicaid