Provider Demographics
NPI:1629968094
Name:SUDDUTH, MORGAN KENNEDY (ACNPC-AG)
Entity type:Individual
Prefix:MRS
First Name:MORGAN
Middle Name:KENNEDY
Last Name:SUDDUTH
Suffix:
Gender:F
Credentials:ACNPC-AG
Other - Prefix:MISS
Other - First Name:MORGAN
Other - Middle Name:KENNEDY
Other - Last Name:GLIDEWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:414 OAK BND
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-7292
Mailing Address - Country:US
Mailing Address - Phone:601-337-0399
Mailing Address - Fax:
Practice Address - Street 1:2500 N STATE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-984-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-08
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS907537363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care