Provider Demographics
NPI:1174110365
Name:MIMS, MORGAN LUCAS (CRNP, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:MORGAN
Middle Name:LUCAS
Last Name:MIMS
Suffix:
Gender:F
Credentials:CRNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:459 COUNTY ROAD 597
Mailing Address - Street 2:
Mailing Address - City:VERBENA
Mailing Address - State:AL
Mailing Address - Zip Code:36091-4280
Mailing Address - Country:US
Mailing Address - Phone:205-908-4391
Mailing Address - Fax:
Practice Address - Street 1:1023 MEDICAL CENTER PKWY STE 401
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:AL
Practice Address - Zip Code:36701-6712
Practice Address - Country:US
Practice Address - Phone:334-418-6614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-22
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-164674363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily