Provider Demographics
NPI:1104808005
Name:MORRIS, KRISTI A (NP-C)
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:A
Last Name:MORRIS
Suffix:
Gender:
Credentials:NP-C
Other - Prefix:
Other - First Name:KRISTI
Other - Middle Name:
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11109 PARKVIEW PLAZA DR # 117
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:128 N RANDOLPH ST
Practice Address - Street 2:
Practice Address - City:GARRETT
Practice Address - State:IN
Practice Address - Zip Code:46738-1138
Practice Address - Country:US
Practice Address - Phone:260-357-6557
Practice Address - Fax:260-357-0373
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001867A363LC1500X, 363LW0102X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200511230Medicaid
IN259990TMedicare PIN
INQ38083Medicare UPIN
IN200511230Medicaid