Provider Demographics
NPI:1841919768
Name:MURPHY, KISHA MONIQUE
Entity type:Individual
Prefix:
First Name:KISHA
Middle Name:MONIQUE
Last Name:MURPHY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 LEDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NORTH BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06471-1813
Mailing Address - Country:US
Mailing Address - Phone:203-909-1899
Mailing Address - Fax:
Practice Address - Street 1:2200 WHITNEY AVE STE 290
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3695
Practice Address - Country:US
Practice Address - Phone:203-903-8308
Practice Address - Fax:203-599-3927
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-24
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT11071363LP2300X, 363LA2200X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care