Provider Demographics
NPI:1265123178
Name:MURPHY, KELLEY DEJUAN (CNA)
Entity type:Individual
Prefix:MRS
First Name:KELLEY
Middle Name:DEJUAN
Last Name:MURPHY
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3129 CANE MILL DR
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31721-7114
Mailing Address - Country:US
Mailing Address - Phone:229-733-1330
Mailing Address - Fax:
Practice Address - Street 1:414 N WESTOVER BLVD STE D6
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-2103
Practice Address - Country:US
Practice Address - Phone:229-329-4004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-19
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0000081168374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide