Provider Demographics
NPI:1427241447
Name:MORRIS, KATHERINE L (NPC)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:L
Last Name:MORRIS
Suffix:
Gender:F
Credentials:NPC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:336 WARNER DR STE 4A
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-4441
Mailing Address - Country:US
Mailing Address - Phone:208-413-3835
Mailing Address - Fax:208-984-1068
Practice Address - Street 1:336 WARNER DR
Practice Address - Street 2:STE 4
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-7301
Practice Address - Country:US
Practice Address - Phone:208-413-3835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-22
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP-812A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID147241447Medicaid
ID1427241447OtherREGENCE BLUE SHIELD
ID1427241447OtherREGENCE BLUE SHIELD
WA0226012OtherLABOR & INDUSTRIES
IDNPZA4OtherBLUE CROSS OF IDAHO
WA1056725Medicaid
IDNPZA4OtherBLUE CROSS OF IDAHO