Provider Demographics
NPI:1497754279
Name:MURPHY, AMANDA D (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:D
Last Name:MURPHY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 PARTRIDGE LOOP
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301
Mailing Address - Country:US
Mailing Address - Phone:270-689-2145
Mailing Address - Fax:270-926-0760
Practice Address - Street 1:1102 TRIPLETT ST
Practice Address - Street 2:STE. 1000
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-3104
Practice Address - Country:US
Practice Address - Phone:270-926-8828
Practice Address - Fax:270-926-0760
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA787363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY95003572Medicaid
KY95003572Medicaid
P98114Medicare UPIN