Provider Demographics
NPI:1811642176
Name:MORALES, JAMIE LEE (AGNP-C)
Entity type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:LEE
Last Name:MORALES
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:MS
Other - First Name:JAMIE
Other - Middle Name:LEE
Other - Last Name:DANIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1230 CLAYTON AVE
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38804-1825
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4381 S EASON BLVD STE 301
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-6584
Practice Address - Country:US
Practice Address - Phone:662-377-3008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-15
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS906304363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner