Provider Demographics
NPI:1487033171
Name:MURRY, KELLY
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:MURRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6041 VILLAGE DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-6619
Mailing Address - Country:US
Mailing Address - Phone:402-423-1900
Mailing Address - Fax:402-423-5991
Practice Address - Street 1:6041 VILLAGE DR
Practice Address - Street 2:SUITE 150
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-6619
Practice Address - Country:US
Practice Address - Phone:402-423-1900
Practice Address - Fax:402-423-5991
Is Sole Proprietor?:No
Enumeration Date:2015-05-27
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111839363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics