Provider Demographics
NPI:1710994884
Name:MCMURRAY, BERKELY A (CNP)
Entity Type:Individual
Prefix:MS
First Name:BERKELY
Middle Name:A
Last Name:MCMURRAY
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:BERKEY
Other - Middle Name:A
Other - Last Name:OLVERA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1200 N BEAVER ST
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-3118
Mailing Address - Country:US
Mailing Address - Phone:928-213-6235
Mailing Address - Fax:928-213-6292
Practice Address - Street 1:167 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:TUBA CITY
Practice Address - State:AZ
Practice Address - Zip Code:86045
Practice Address - Country:US
Practice Address - Phone:928-283-2094
Practice Address - Fax:928-283-2677
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP000619363L00000X
AZAP4122363L00000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ799080Medicaid