Healthcare Provider Details

I. General information

NPI: 1629247887
Provider Name (Legal Business Name): KERRI L MURPHY PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2008
Last Update Date: 11/24/2021
Certification Date: 11/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6609 W GREENFIELD AVE
WEST ALLIS WI
53214-4958
US

IV. Provider business mailing address

3301 W FOREST HOME AVE
MILWAUKEE WI
53215-2843
US

V. Phone/Fax

Practice location:
  • Phone: 414-257-8577
  • Fax:
Mailing address:
  • Phone: 414-257-8577
  • Fax: 847-382-9155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085002409
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4064
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: