Provider Demographics
NPI:1780141234
Name:FUNK, MORGAN TAYLOR (AGPCNP-BC)
Entity type:Individual
Prefix:MS
First Name:MORGAN
Middle Name:TAYLOR
Last Name:FUNK
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MOMENCE
Mailing Address - State:IL
Mailing Address - Zip Code:60954-1521
Mailing Address - Country:US
Mailing Address - Phone:815-954-9419
Mailing Address - Fax:
Practice Address - Street 1:375 N WALL ST STE P510
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-3492
Practice Address - Country:US
Practice Address - Phone:815-935-0750
Practice Address - Fax:815-935-8797
Is Sole Proprietor?:No
Enumeration Date:2019-02-20
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209018480363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health