Provider Demographics
NPI:1801534359
Name:MURPHREY, NICHOLAUS PAUL (MS RD)
Entity type:Individual
Prefix:
First Name:NICHOLAUS
Middle Name:PAUL
Last Name:MURPHREY
Suffix:
Gender:M
Credentials:MS RD
Other - Prefix:
Other - First Name:NICK
Other - Middle Name:P
Other - Last Name:MURPHREY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:544 ASHWOOD BND
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-6841
Mailing Address - Country:US
Mailing Address - Phone:936-414-0720
Mailing Address - Fax:
Practice Address - Street 1:2315 STOCKTON BLVD # A
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2201
Practice Address - Country:US
Practice Address - Phone:916-734-2011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT83970133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX86048987OtherCOMMISSION ON DIETETIC REGISTRATION