Provider Demographics
NPI:1992066310
Name:MORGAN, LEA SHAWN (RN BSW)
Entity type:Individual
Prefix:MRS
First Name:LEA
Middle Name:SHAWN
Last Name:MORGAN
Suffix:
Gender:F
Credentials:RN BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 DRY HILL ROAD
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801
Mailing Address - Country:US
Mailing Address - Phone:304-253-6060
Mailing Address - Fax:304-929-2248
Practice Address - Street 1:275 DRY HILL ROAD
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801
Practice Address - Country:US
Practice Address - Phone:304-253-6060
Practice Address - Fax:304-929-2248
Is Sole Proprietor?:No
Enumeration Date:2012-06-01
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV69413363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner