Healthcare Provider Details

I. General information

NPI: 1306650437
Provider Name (Legal Business Name): LETISHA MURPHY CSFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TISH MURPHY CSFA

II. Dates (important events)

Enumeration Date: 02/07/2025
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 13TH ST
GULFPORT MS
39501-2515
US

IV. Provider business mailing address

116 PINE TREE RD
BAY SAINT LOUIS MS
39520-2134
US

V. Phone/Fax

Practice location:
  • Phone: 228-867-4000
  • Fax:
Mailing address:
  • Phone: 228-222-0082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246XC2901X
TaxonomyCardiovascular Invasive Specialist/Technologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code246XC2903X
TaxonomyVascular Specialist/Technologist Cardiovascular
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: