MEDICARE: KELLY ELIZABETH MCMURRAY CPO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224P00000X	Prosthetist	PRO0000000277	TN
2	222Z00000X	Orthotist	ORT0000000291	TN

General Provider Information

NPI Number	:	1972315224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY ELIZABETH MCMURRAY CPO

Provider Business Mailing Address
First Line	:	3816 LATROBE DR STE 103
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-1373
Country	:	US
Telephone Number	:	704-247-4134
Fax Number	:	704-257-8001

Provider Business Practice Location Address
First Line	:	3816 LATROBE DR STE 103
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-1373
Country	:	US
Telephone Number	:	704-247-4134
Fax Number	:	704-257-8001

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2025
Last Update Date	:	01/23/2025

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