Provider Demographics
NPI:1841447059
Name:MORRISON, MARY J (APRN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:J
Last Name:MORRISON
Suffix:
Gender:F
Credentials:APRN
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Mailing Address - Street 1:5722 OUTER LOOP
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40219-4156
Mailing Address - Country:US
Mailing Address - Phone:502-492-7455
Mailing Address - Fax:502-921-0222
Practice Address - Street 1:1327 E BROADWAY ST STE B
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-1599
Practice Address - Country:US
Practice Address - Phone:270-283-4240
Practice Address - Fax:270-283-4556
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-20
Last Update Date:2020-10-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY3005681363LW0102X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100394100Medicaid