Basic Information
| Provider Information | |||||||||
| NPI: | 1558470815 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MURPHY | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | EDWARD | ||||||||
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| Credential: | APN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 879 | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727020879 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4797137115 | ||||||||
| FaxNumber: | 4797137186 | ||||||||
| Practice Location | |||||||||
| Address1: | 146 PASSION PLAY RD | ||||||||
| Address2: | |||||||||
| City: | EUREKA SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 726329495 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4792539746 | ||||||||
| FaxNumber: | 4792532464 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | A01775 | AR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 5T894 | 01 | AR | BLUE CROSS | OTHER |