Provider Demographics
NPI:1003859182
Name:MURPHY, JEANNIE K (CRNA)
Entity Type:Individual
Prefix:
First Name:JEANNIE
Middle Name:K
Last Name:MURPHY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JEANNIE
Other - Middle Name:M
Other - Last Name:KRAMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 840853
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0853
Mailing Address - Country:US
Mailing Address - Phone:972-715-5000
Mailing Address - Fax:972-715-9976
Practice Address - Street 1:6606 LBJ FWY
Practice Address - Street 2:SUITE 200
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-6533
Practice Address - Country:US
Practice Address - Phone:972-715-5000
Practice Address - Fax:972-715-9976
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX507018367500000X
TXAP103063367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX109724812Medicaid
TX109724816Medicaid
TX109724806Medicaid
TX109724808Medicaid
TX8566UJOtherBCBS
TX109724806Medicaid
P00413829Medicare PIN
TX321838YK6UMedicare PIN
TX109724816Medicaid
8L12414Medicare PIN
8J5203Medicare PIN