Provider Demographics
NPI:1336555713
Name:MURRAY, ELAINE B (FNP-C, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:B
Last Name:MURRAY
Suffix:
Gender:F
Credentials:FNP-C, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1450
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:TN
Mailing Address - Zip Code:38478-1450
Mailing Address - Country:US
Mailing Address - Phone:931-292-6007
Mailing Address - Fax:
Practice Address - Street 1:100 S 2ND ST
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:TN
Practice Address - Zip Code:38478-3219
Practice Address - Country:US
Practice Address - Phone:931-292-6007
Practice Address - Fax:931-325-6722
Is Sole Proprietor?:No
Enumeration Date:2014-07-07
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-175373363L00000X
VA24177012363L00000X
TN18812363LF0000X, 363LP0808X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ009252Medicaid
TNQ009252Medicaid