1902824170 NPI number — MRS. JENNIFER S MORRIS CRNA

Table of content: MRS. JENNIFER S MORRIS CRNA (NPI 1902824170)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902824170 NPI number — MRS. JENNIFER S MORRIS CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORRIS
Provider First Name:
JENNIFER
Provider Middle Name:
S
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902824170
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/29/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 771522
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38177-1522
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-249-7668
Provider Business Mailing Address Fax Number:
901-261-2542

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1601 NEW CASTLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORREST CITY
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72335-2218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-261-0513
Provider Business Practice Location Address Fax Number:
870-261-0535
Provider Enumeration Date:
07/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  C01532 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 157071001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1902824170 . This is a "TRICARE - SOUTH REGION" identifier . This identifiers is of the category "OTHER".
  • Identifier: P01061008 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 1902824170 . This is a "BAPTIST HEALTH SERVICES GROUP, INC" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 5Y423 . This is a "ARKANSAS BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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