Provider Demographics
NPI:1992071591
Name:MORISSETTE, MYRA KAY (CRNP)
Entity type:Individual
Prefix:
First Name:MYRA
Middle Name:KAY
Last Name:MORISSETTE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1369A GEORGE WALLACE HWY
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35654-3281
Mailing Address - Country:US
Mailing Address - Phone:256-331-9700
Mailing Address - Fax:256-331-2615
Practice Address - Street 1:1369A GEORGE WALLACE HWY
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AL
Practice Address - Zip Code:35654-3281
Practice Address - Country:US
Practice Address - Phone:256-331-9700
Practice Address - Fax:256-331-2615
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1129315363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health