MEDICARE: KELLY CORINNE MURPHY RDN, LD

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	133V00000X	Registered Dietitian	DT82899	TX

General Provider Information

NPI Number	:	1386068120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY CORINNE MURPHY RDN, LD

Provider Business Mailing Address
First Line	:	2801 LIVE OAK ST
Second Line	:	4301
City	:	DALLAS
State	:	TX
Zip	:	75204-5711
Country	:	US
Telephone Number	:	214-414-9772
Fax Number	:

Provider Business Practice Location Address
First Line	:	2801 LIVE OAK ST
Second Line	:	4301
City	:	DALLAS
State	:	TX
Zip	:	75204-5711
Country	:	US
Telephone Number	:	214-414-9772
Fax Number	:

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

Provider Enumeration Date	:	02/14/2014
Last Update Date	:	06/19/2015

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