Basic Information
| Provider Information | |||||||||
| NPI: | 1275717753 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MORRIS | ||||||||
| FirstName: | LARA | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | UK DIVISION OF HEMATOLOGY | ||||||||
| Address2: | 800 ROSE ST | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KENTUCKY | ||||||||
| PostalCode: | 40536 | ||||||||
| CountryCode: | UM | ||||||||
| TelephoneNumber: | 8592576006 | ||||||||
| FaxNumber: | 8593232749 | ||||||||
| Practice Location | |||||||||
| Address1: | UK DIVISION OF HEMATOLOGY | ||||||||
| Address2: | 800 ROSE ST. | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405360093 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592576006 | ||||||||
| FaxNumber: | 8593232749 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2007 | ||||||||
| LastUpdateDate: | 12/12/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | 3005400 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | 363L00000X | 3005400 | KY | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 7100055470 | 05 | KY | MEDICAID |