Provider Demographics
NPI:1235155722
Name:MURPHY, STACI C (FNP, PNP)
Entity Type:Individual
Prefix:
First Name:STACI
Middle Name:C
Last Name:MURPHY
Suffix:
Gender:F
Credentials:FNP, PNP
Other - Prefix:
Other - First Name:STACI
Other - Middle Name:C
Other - Last Name:PERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP, PNP
Mailing Address - Street 1:1200 S ROGERS ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-4792
Mailing Address - Country:US
Mailing Address - Phone:812-339-6434
Mailing Address - Fax:812-331-0196
Practice Address - Street 1:1200 S ROGERS ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-4792
Practice Address - Country:US
Practice Address - Phone:812-339-6434
Practice Address - Fax:812-331-0196
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002004A363L00000X, 207N00000X, 363LF0000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200531520Medicaid
INQ53216Medicare UPIN
IN563420Medicare ID - Type UnspecifiedGROUP MEDICARE NO.
IN563420VMedicare ID - Type UnspecifiedINDIVIDUAL MEDICARE NO.