Provider Demographics
NPI:1780799254
Name:MORRISON, RACHEL K (PA)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:K
Last Name:MORRISON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1005 HEALTH CENTER DR STE 201
Mailing Address - Street 2:
Mailing Address - City:MATTOON
Mailing Address - State:IL
Mailing Address - Zip Code:61938-4693
Mailing Address - Country:US
Mailing Address - Phone:217-238-6055
Mailing Address - Fax:217-258-2216
Practice Address - Street 1:890 E RIDGELAWN RD
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62442-2551
Practice Address - Country:US
Practice Address - Phone:217-382-4191
Practice Address - Fax:217-382-4248
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL85002747363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL311661293OtherPERSONAL CARE
IL01225376OtherBLUE CROSS BLUE SHIELD
IL311661293001Medicaid
IL098671OtherHEALTH ALLIANCE