Basic Information
Provider Information
NPI: 1831465582
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WAGES
FirstName: MORGAN
MiddleName: RACHELLE
NamePrefix: MRS.
NameSuffix:  
Credential: APN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 400
Address2:  
City: JACKSON
State: TN
PostalCode: 383020400
CountryCode: US
TelephoneNumber: 7314238697
FaxNumber: 7314225743
Practice Location
Address1: 2863 HIGHWAY 45 BYP
Address2:  
City: JACKSON
State: TN
PostalCode: 383053618
CountryCode: US
TelephoneNumber: 7314220213
FaxNumber: 7316608366
Other Information
ProviderEnumerationDate: 03/27/2012
LastUpdateDate: 04/22/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X0000016437TNY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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