Provider Demographics
NPI:1588148571
Name:MORGAN, JEREMY M (APRN)
Entity type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:M
Last Name:MORGAN
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 NW 182ND ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-4161
Mailing Address - Country:US
Mailing Address - Phone:405-686-3506
Mailing Address - Fax:
Practice Address - Street 1:10201 N MAY AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-2510
Practice Address - Country:US
Practice Address - Phone:405-631-0611
Practice Address - Fax:405-631-0811
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-17
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK103510363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily