Provider Demographics
NPI:1447876511
Name:GUSTIN, MORGAN OLIVIA (MSPA, PA-C)
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:OLIVIA
Last Name:GUSTIN
Suffix:
Gender:F
Credentials:MSPA, PA-C
Other - Prefix:
Other - First Name:MORGAN
Other - Middle Name:OLIVIA
Other - Last Name:CAREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:13225 ROADSTER DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-1660
Mailing Address - Country:US
Mailing Address - Phone:469-815-3511
Mailing Address - Fax:
Practice Address - Street 1:2217 PARK BEND DR STE 300
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-5674
Practice Address - Country:US
Practice Address - Phone:512-382-1933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-24
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA13705363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant