Provider Demographics
NPI:1477713311
Name:MURRAY, KATHLEEN FONTAINE (DO)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:FONTAINE
Last Name:MURRAY
Suffix:
Gender:F
Credentials:DO
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 1595
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-1595
Mailing Address - Country:US
Mailing Address - Phone:606-408-6200
Mailing Address - Fax:606-408-6612
Practice Address - Street 1:912 PARK AVE
Practice Address - Street 2:
Practice Address - City:IRONTON
Practice Address - State:OH
Practice Address - Zip Code:45638-1596
Practice Address - Country:US
Practice Address - Phone:740-534-0021
Practice Address - Fax:740-534-0029
Is Sole Proprietor?:No
Enumeration Date:2008-06-13
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4794207Q00000X
KY03941207Q00000X
KYTP840207Q00000X
OH34.012120207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKOKAAA1626OtherMEDICARE PTAN
WV3810027558Medicaid
OK200250710AMedicaid
OH0158557Medicaid
OHH397410Medicare PIN