1316077829 NPI number — NANCY ANN CHILDRESS-MURPHY D.O.

Table of content: NANCY ANN CHILDRESS-MURPHY D.O. (NPI 1316077829)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316077829 NPI number — NANCY ANN CHILDRESS-MURPHY D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHILDRESS-MURPHY
Provider First Name:
NANCY
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MURPHY
Provider Other First Name:
NANCY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.O.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1316077829
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/12/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14536 E 550 RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INOLA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74036-5301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1755 STATE HWY 66
Provider Second Line Business Practice Location Address:
SUITE F
Provider Business Practice Location Address City Name:
CATOOSA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-739-4885
Provider Business Practice Location Address Fax Number:
918-739-4886
Provider Enumeration Date:
03/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  4542 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200196760A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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