Provider Demographics
NPI:1538160957
Name:MORTON, ELIZABETH T (PA C)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:T
Last Name:MORTON
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 950132
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0132
Mailing Address - Country:US
Mailing Address - Phone:888-980-8992
Mailing Address - Fax:
Practice Address - Street 1:3810 SPRINGHURST BLVD STE 200
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241
Practice Address - Country:US
Practice Address - Phone:502-583-1749
Practice Address - Fax:502-329-8184
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA590363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P15776Medicare UPIN
KY9500098000Medicaid
KY970029728OtherRAILROAD MEDICARE PIN
0356604Medicare ID - Type Unspecified