Individual provider Active NPI

Gerald Dwayne Morris II, CPNP

  • Pediatric Nurse Practitioner
  • Woodville, TX
National Provider Identifier
1164760039
Registry record updated Apr 10, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
746539 Issued in TX
Practice address
900 W Bluff St
Woodville, TX 75979-4734
Phone
(409) 283-2090
Fax
(409) 283-2097
NPI assigned
Jan 28, 2013
Last updated
Apr 10, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X 746539 TX Primary

Addresses

Primary practice location

900 W Bluff St
Woodville, TX 75979-4734

Mailing address

900 W Bluff St
Woodville, TX 75979-4734
Phone (409) 283-2090

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Certified Pediatric Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
746539TXMDPediatric Nurse Practitioner

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1359331200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1491782400000",
    "number": "1164760039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 W BLUFF ST",
            "city": "WOODVILLE",
            "state": "TX",
            "postal_code": "759794734",
            "telephone_number": "409-283-2090",
            "fax_number": "409-283-2097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 W BLUFF ST",
            "city": "WOODVILLE",
            "state": "TX",
            "postal_code": "759794734",
            "telephone_number": "409-283-2090",
            "fax_number": "409-283-2097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORRIS",
        "first_name": "GERALD",
        "middle_name": "DWAYNE",
        "name_prefix": "Mr.",
        "name_suffix": "II",
        "credential": "CPNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-01-28",
        "last_updated": "2017-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "TX",
            "license": "746539",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodville, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.