Provider Demographics
NPI:1700116415
Name:MORRIS, ROY ALAN (CRNA)
Entity Type:Individual
Prefix:MR
First Name:ROY
Middle Name:ALAN
Last Name:MORRIS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:KY
Mailing Address - Zip Code:40177-1142
Mailing Address - Country:US
Mailing Address - Phone:502-533-2526
Mailing Address - Fax:
Practice Address - Street 1:1112 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:KY
Practice Address - Zip Code:40177
Practice Address - Country:US
Practice Address - Phone:502-533-2526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-31
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1105791163W00000X
KY6345A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse