Provider Demographics
NPI:1841001807
Name:EDMONDSON, MORGAN MAE (PA)
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:MAE
Last Name:EDMONDSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MORGAN
Other - Middle Name:MAE
Other - Last Name:HACKBARTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2700 EVENING SIDE CT
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76179-1706
Mailing Address - Country:US
Mailing Address - Phone:214-449-4645
Mailing Address - Fax:
Practice Address - Street 1:2700 EVENING SIDE CT
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76179-1706
Practice Address - Country:US
Practice Address - Phone:214-449-4645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-17
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant