Healthcare Provider Details

I. General information

NPI: 1457081440
Provider Name (Legal Business Name): KELVIN LEVAN MURRY PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2022
Last Update Date: 07/05/2022
Certification Date: 07/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 WINTON BLOUNT LOOP
MONTGOMERY AL
36117-3507
US

IV. Provider business mailing address

233 WINTON BLOUNT LOOP
MONTGOMERY AL
36117-3507
US

V. Phone/Fax

Practice location:
  • Phone: 256-384-8264
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1-145208
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: