Basic Information
Provider Information
NPI: 1760840581
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MORGAN
FirstName: JESS
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: FNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 13555 W MCDOWELL RD
Address2:  
City: GOODYEAR
State: AZ
PostalCode: 853952624
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 13555 W MCDOWELL RD STE 205
Address2:  
City: GOODYEAR
State: AZ
PostalCode: 853952626
CountryCode: US
TelephoneNumber: 6232951190
FaxNumber: 6024298595
Other Information
ProviderEnumerationDate: 02/08/2016
LastUpdateDate: 07/01/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/01/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XAP8451AZY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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