Provider Demographics
NPI:1831575521
Name:RADER, MORGAN BRYN (APRN)
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:BRYN
Last Name:RADER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:CANADIAN
Mailing Address - State:TX
Mailing Address - Zip Code:79014-3315
Mailing Address - Country:US
Mailing Address - Phone:806-323-1100
Mailing Address - Fax:806-323-8109
Practice Address - Street 1:1020 S 4TH ST
Practice Address - Street 2:
Practice Address - City:CANADIAN
Practice Address - State:TX
Practice Address - Zip Code:79014-3315
Practice Address - Country:US
Practice Address - Phone:806-323-1100
Practice Address - Fax:806-323-8109
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP128712363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner