Provider Demographics
NPI:1770513202
Name:MORSEA, KATHRYN ANN (MD)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ANN
Last Name:MORSEA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:516 NIZHONI BLVD
Mailing Address - Street 2:BOX 1337
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87301-5748
Mailing Address - Country:US
Mailing Address - Phone:505-722-1000
Mailing Address - Fax:505-726-8740
Practice Address - Street 1:516 NIZHONI BLVD
Practice Address - Street 2:BOX 1337
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301
Practice Address - Country:US
Practice Address - Phone:505-722-1000
Practice Address - Fax:505-726-8740
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG79806207Q00000X, 207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00077473Medicaid
AZ501719Medicaid
TX8HZ135Medicare ID - Type UnspecifiedHSZ001
NM00077473Medicaid
TX8HZ147Medicare ID - Type UnspecifiedHSZ006
TX8HC064Medicare ID - Type UnspecifiedHSZ197
TX8HZ09QMedicare ID - Type UnspecifiedHSZ003
AZ501719Medicaid
TX8HZ057Medicare ID - Type UnspecifiedHSZ005