Provider Demographics
NPI:1972342731
Name:SHREVE, AUDREY MORGAN (MD)
Entity type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:MORGAN
Last Name:SHREVE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1181 COUNTY ROAD 1613
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75766-8479
Mailing Address - Country:US
Mailing Address - Phone:903-516-2117
Mailing Address - Fax:
Practice Address - Street 1:3601 4TH ST STOP 6211
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79430-6211
Practice Address - Country:US
Practice Address - Phone:806-743-6147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program