Healthcare Provider Details

I. General information

NPI: 1992206536
Provider Name (Legal Business Name): MICHELLE MCMURRAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2018
Last Update Date: 05/24/2022
Certification Date: 05/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

363 W LINCOLN TRAIL BLVD
RADCLIFF KY
40160-3302
US

IV. Provider business mailing address

635 S MAIN ST STE B
LEITCHFIELD KY
42754-1056
US

V. Phone/Fax

Practice location:
  • Phone: 270-352-1133
  • Fax:
Mailing address:
  • Phone: 270-287-0656
  • Fax: 270-230-0328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-20-42199
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: