Provider Demographics
NPI:1821388836
Name:MURRAY, KELLY JENA (NP)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:JENA
Last Name:MURRAY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:JENA
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:2400 BELLEVUE RD STE 21A
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-2890
Mailing Address - Country:US
Mailing Address - Phone:478-328-0281
Mailing Address - Fax:478-327-0438
Practice Address - Street 1:212 HOSPITAL DR
Practice Address - Street 2:SUITE C
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-4207
Practice Address - Country:US
Practice Address - Phone:478-922-9281
Practice Address - Fax:478-929-4518
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN187026363L00000X, 363LA2200X, 363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN187026OtherSTATE LICENSE
GA003109698Medicaid
GA202I509696Medicare PIN