Provider Demographics
NPI:1245205426
Name:MURPHY, MARY K (MSN APRN BC-FNP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:K
Last Name:MURPHY
Suffix:
Gender:F
Credentials:MSN APRN BC-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 390
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-0390
Mailing Address - Country:US
Mailing Address - Phone:304-636-9242
Mailing Address - Fax:304-636-8152
Practice Address - Street 1:909 GORMAN AVE
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-4109
Practice Address - Country:US
Practice Address - Phone:304-636-9242
Practice Address - Fax:304-636-8152
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV35192363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV02639382OtherANCC
WV001710221OtherMTN STATE BC/BS PAY TO 1
WV35192OtherWV APRN, BC LICENSE
WVRXA1276OtherWV PRESCRIPTIVE PRIVILEGE
WV001768018OtherMTN STATE BC/BS SERVICE
WV00349930OtherANA WV NURSES ASSOC
WV734583OtherNCPPO
WV500014647OtherRAILROAD MEDICARE
WVFQ35192OtherHEALTH PLAN PROVIDER
WV001967354OtherMTN STATE BC/BS PAY TO 2
WV3810005339Medicaid
WV1047478OtherBRICKSTREET WORKERS COMP
WV1047478OtherBRICKSTREET WORKERS COMP
WVS99558Medicare UPIN
WV00349930OtherANA WV NURSES ASSOC
WVFQ35192OtherHEALTH PLAN PROVIDER