Provider Demographics
NPI:1962212290
Name:SMITH, MORGAN A (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:A
Last Name:SMITH
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:MORGAN
Other - Middle Name:A
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:160 S LOOMIS RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-8715
Mailing Address - Country:US
Mailing Address - Phone:989-621-9045
Mailing Address - Fax:
Practice Address - Street 1:1335 PINE AVE
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:MI
Practice Address - Zip Code:48801-1242
Practice Address - Country:US
Practice Address - Phone:989-463-2181
Practice Address - Fax:989-463-1713
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-09
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704303441363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner