Healthcare Provider Details

I. General information

NPI: 1083014690
Provider Name (Legal Business Name): KIMBERLY MURPHY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2014
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6535 ROCHESTER RD STE 102
TROY MI
48085-1362
US

IV. Provider business mailing address

300 68TH ST SE
GRAND RAPIDS MI
49548-6927
US

V. Phone/Fax

Practice location:
  • Phone: 248-813-0060
  • Fax: 248-813-0066
Mailing address:
  • Phone: 616-281-6372
  • Fax: 616-281-6459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5601007016
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: