1720326200 NPI number — MS. SHAVONNE F MORGAN FNP-BC

Table of content: MS. SHAVONNE F MORGAN FNP-BC (NPI 1720326200)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720326200 NPI number — MS. SHAVONNE F MORGAN FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORGAN
Provider First Name:
SHAVONNE
Provider Middle Name:
F
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
FNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FRIERSON
Provider Other First Name:
SHAVONEE
Provider Other Middle Name:
R
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
FNP-BC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1720326200
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/28/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
854 W JAMES CAMPBELL BLVD
Provider Second Line Business Mailing Address:
SUITE 303
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38401-4659
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
931-380-0075
Provider Business Mailing Address Fax Number:
931-388-7502

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
854 W JAMES CAMPBELL BLVD
Provider Second Line Business Practice Location Address:
SUITE 403
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38401-4659
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-380-0075
Provider Business Practice Location Address Fax Number:
931-388-7502
Provider Enumeration Date:
01/18/2013

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: 363LF0000X , with the licence number:  17110 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3710089 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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