Basic Information
Provider Information | |||||||||
NPI: | 1558786673 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MCMURPHY | ||||||||
FirstName: | KENDALL | ||||||||
MiddleName: | SANDERS | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | C.R.N.A. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 3488 | ||||||||
Address2: |   | ||||||||
City: | TUPELO | ||||||||
State: | MS | ||||||||
PostalCode: | 388033488 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3176149863 | ||||||||
FaxNumber: | 8448760873 | ||||||||
Practice Location | |||||||||
Address1: | 2809 DENNY AVE | ||||||||
Address2: |   | ||||||||
City: | PASCAGOULA | ||||||||
State: | MS | ||||||||
PostalCode: | 39581 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2288181111 | ||||||||
FaxNumber: | 8448760873 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/26/2014 | ||||||||
LastUpdateDate: | 11/21/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | RN257526 | GA | N |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |   | 367500000X | AP07626 | LA | N |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |   | 367500000X | 901559 | MS | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |   |
No ID Information.