Provider Demographics
NPI:1770698235
Name:MCMURRY, RUSSELL DALE (ACNP)
Entity type:Individual
Prefix:
First Name:RUSSELL
Middle Name:DALE
Last Name:MCMURRY
Suffix:
Gender:
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8603
Mailing Address - Fax:
Practice Address - Street 1:101 BUSINESS PARK BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-8401
Practice Address - Country:US
Practice Address - Phone:803-296-7846
Practice Address - Fax:803-296-9699
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1616363L00000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP0584Medicaid
SCP53075Medicare UPIN
SCP530751661Medicare PIN
SCAA71215736Medicare PIN
SCP530758946Medicare PIN
SCNP0584Medicaid