Provider Demographics
NPI:1245289693
Name:MURPHY, MARY NELL (FNP,MSN)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:NELL
Last Name:MURPHY
Suffix:
Gender:F
Credentials:FNP,MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3960 COVINGTON PIKE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38135-2282
Mailing Address - Country:US
Mailing Address - Phone:901-516-5200
Mailing Address - Fax:
Practice Address - Street 1:3960 COVINGTON PIKE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38135-2282
Practice Address - Country:US
Practice Address - Phone:901-516-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3928623Medicaid
TN3928623Medicaid
TNQ16025Medicare UPIN
3928623Medicare PIN