Provider Demographics
NPI:1326100322
Name:MURPHY, KATHLEEN J (PA)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:J
Last Name:MURPHY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 GRAHAM RD W
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1055
Mailing Address - Country:US
Mailing Address - Phone:607-257-2188
Mailing Address - Fax:607-266-7341
Practice Address - Street 1:10 GRAHAM RD W
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1055
Practice Address - Country:US
Practice Address - Phone:607-257-2188
Practice Address - Fax:607-266-7341
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L-27193174N00000X
NY010306-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No174N00000XOther Service ProvidersLactation Consultant, Non-RN
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02668880Medicaid
NY02668880Medicaid