Provider Demographics
NPI:1124671953
Name:HARDISON, MORGAN TAYLOR
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:TAYLOR
Last Name:HARDISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2946 WINFIELD DUNN PKWY
Mailing Address - Street 2:STE 107
Mailing Address - City:KODAK
Mailing Address - State:TN
Mailing Address - Zip Code:37764-4316
Mailing Address - Country:US
Mailing Address - Phone:865-705-8831
Mailing Address - Fax:
Practice Address - Street 1:2946 WINFIELD DUNN PKWY
Practice Address - Street 2:
Practice Address - City:KODAK
Practice Address - State:TN
Practice Address - Zip Code:37764-4306
Practice Address - Country:US
Practice Address - Phone:865-933-9950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-21
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2019040827363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner