Provider Demographics
NPI:1609243203
Name:MURPHY, TERESA DIANN (RD, LD)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:DIANN
Last Name:MURPHY
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 LEES VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:SHEPHERDSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40165-6143
Mailing Address - Country:US
Mailing Address - Phone:502-955-7837
Mailing Address - Fax:502-543-2998
Practice Address - Street 1:181 LEES VALLEY RD
Practice Address - Street 2:
Practice Address - City:SHEPHERDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40165-6143
Practice Address - Country:US
Practice Address - Phone:502-955-7837
Practice Address - Fax:502-543-2998
Is Sole Proprietor?:No
Enumeration Date:2015-08-31
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2542133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY61-1034216OtherBULLITT COUNTY HEALTH DEPARTMENT TIN