Provider Demographics
NPI:1740343680
Name:MURPHY GORMAN, JUDY ANN (AHNP)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:ANN
Last Name:MURPHY GORMAN
Suffix:
Gender:F
Credentials:AHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-3420
Mailing Address - Country:US
Mailing Address - Phone:518-563-8880
Mailing Address - Fax:518-562-1077
Practice Address - Street 1:8 BROAD STREET
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901
Practice Address - Country:US
Practice Address - Phone:518-563-8880
Practice Address - Fax:518-562-1077
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY300218363LA2200X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02200448Medicaid
S89732Medicare UPIN
NYBB6838Medicare ID - Type Unspecified