Provider Demographics
NPI:1104296508
Name:MORRISON, MARY RAFAELA (PMHNP- BC)
Entity type:Individual
Prefix:
First Name:MARY RAFAELA
Middle Name:
Last Name:MORRISON
Suffix:
Gender:F
Credentials:PMHNP- BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:951 COURT AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-2813
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:951 COURT AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-2813
Practice Address - Country:US
Practice Address - Phone:901-577-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-29
Last Update Date:2025-01-27
Deactivation Date:2016-07-07
Deactivation Code:
Reactivation Date:2023-11-22
Provider Licenses
StateLicense IDTaxonomies
TN35276363LP0808X
NYF405457-01363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health