MEDICARE: KELSI NICHOLE MURPHY PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1316673007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSI NICHOLE MURPHY PA-C

Provider Business Mailing Address
First Line	:	5292 S COLLEGE DR STE 202
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84123-2960
Country	:	US
Telephone Number	:	801-590-4508
Fax Number	:

Provider Business Practice Location Address
First Line	:	5292 S COLLEGE DR STE 202
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84123-2960
Country	:	US
Telephone Number	:	801-590-4508
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2022
Last Update Date	:	08/20/2024

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