Provider Demographics
NPI:1689400822
Name:MORROW, KARISSA (FNP)
Entity type:Individual
Prefix:
First Name:KARISSA
Middle Name:
Last Name:MORROW
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S PENNSYLVANIA AVE SPC 89
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92410-2178
Mailing Address - Country:US
Mailing Address - Phone:909-714-4973
Mailing Address - Fax:
Practice Address - Street 1:201 S PENNSYLVANIA AVE SPC 89
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92410-2178
Practice Address - Country:US
Practice Address - Phone:909-714-4973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-13
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95030294363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care