1497754279 NPI number — MRS. AMANDA D. MURPHY P.A.-C

Table of content: MRS. AMANDA D. MURPHY P.A.-C (NPI 1497754279)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497754279 NPI number — MRS. AMANDA D. MURPHY P.A.-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MURPHY
Provider First Name:
AMANDA
Provider Middle Name:
D.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
P.A.-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497754279
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/11/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
169 PARTRIDGE LOOP
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OWENSBORO
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-689-2145
Provider Business Mailing Address Fax Number:
270-926-0760

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1102 TRIPLETT ST
Provider Second Line Business Practice Location Address:
STE. 1000
Provider Business Practice Location Address City Name:
OWENSBORO
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42303-3104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-926-8828
Provider Business Practice Location Address Fax Number:
270-926-0760
Provider Enumeration Date:
07/14/2005

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: 363A00000X , with the licence number:  PA787 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 95003572 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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