Provider Demographics
NPI:1720429459
Name:ROCKEL, MORGEN TERRELL (PA-C, RD)
Entity Type:Individual
Prefix:
First Name:MORGEN
Middle Name:TERRELL
Last Name:ROCKEL
Suffix:
Gender:F
Credentials:PA-C, RD
Other - Prefix:
Other - First Name:MORGEN
Other - Middle Name:ALICIA
Other - Last Name:TERRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:325 TAMARACK LN
Mailing Address - Street 2:
Mailing Address - City:SHILOH
Mailing Address - State:IL
Mailing Address - Zip Code:62269
Mailing Address - Country:US
Mailing Address - Phone:618-624-2060
Mailing Address - Fax:
Practice Address - Street 1:325 TAMARACK LN.
Practice Address - Street 2:
Practice Address - City:SHILOH
Practice Address - State:IL
Practice Address - Zip Code:62269
Practice Address - Country:US
Practice Address - Phone:618-624-2060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-10
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010003528133V00000X
133V00000X
IL085.006580363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered