Provider Demographics
NPI:1356325005
Name:MURPHY, JESSICA L (DO)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:L
Last Name:MURPHY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LEAH
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 729
Mailing Address - Street 2:72 RED OAK DRIVE
Mailing Address - City:CRAIGSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26205-0729
Mailing Address - Country:US
Mailing Address - Phone:304-742-5200
Mailing Address - Fax:304-742-5214
Practice Address - Street 1:72 RED OAK DRIVE
Practice Address - Street 2:
Practice Address - City:CRAIGSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26205-0729
Practice Address - Country:US
Practice Address - Phone:304-742-5200
Practice Address - Fax:304-742-5214
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-05
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1830207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV180256100Medicaid
WV1802561000Medicaid
WV001723054OtherMS BCBS
WV001723054OtherMS BCBS
WV5118971Medicare PIN
WV511827Medicare Oscar/Certification
WV1802561000Medicaid
WV5118271Medicare PIN
WV511897Medicare Oscar/Certification
WVD518361Medicare PIN