Provider Demographics
NPI:1831743343
Name:MORGAN, KASSIE K (LAC, DIPLOM)
Entity type:Individual
Prefix:
First Name:KASSIE
Middle Name:K
Last Name:MORGAN
Suffix:
Gender:F
Credentials:LAC, DIPLOM
Other - Prefix:
Other - First Name:KASSIE
Other - Middle Name:KIMBERLY
Other - Last Name:KINARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:50 BELL ROCK PLZ
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86351-8804
Mailing Address - Country:US
Mailing Address - Phone:928-284-4038
Mailing Address - Fax:
Practice Address - Street 1:50 BELL ROCK PLZ
Practice Address - Street 2:
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86351-8804
Practice Address - Country:US
Practice Address - Phone:928-284-4038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-01
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-010067171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist