Basic Information
| Provider Information | |||||||||
| NPI: | 1215996764 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MURPHY | ||||||||
| FirstName: | TRICIA | ||||||||
| MiddleName: | BERNICE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6355 S BUFFALO DR FL 3 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891132133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022163346 | ||||||||
| FaxNumber: | 7026716883 | ||||||||
| Practice Location | |||||||||
| Address1: | 821 N NELLIS BLVD | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891105339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024384003 | ||||||||
| FaxNumber: | 7024380555 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2006 | ||||||||
| LastUpdateDate: | 10/19/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 13551 | PR | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 0000 | NV | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0300X | 13551 | PR | N | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine | 207RG0300X | ME118894 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine | 208M00000X | 13551 | PR | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 16417 | NV | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1215996764 | 05 | NV | MEDICAID | 9710004 | 01 | PR | HUMANA | OTHER | 13516226 | 01 | FL | CAQH | OTHER | 16417 | 01 | NV | STATE LICENSE | OTHER | 212848 | 01 | PR | PREFERRED HEALTH | OTHER | 21674PE | 01 | PR | SSS | OTHER | 014564000 | 05 | FL | MEDICAID | 14XIV | 01 | FL | BLUE CROSS BLUE SHIELD | OTHER |