MEDICARE: SHANE TIMOTHY MCMURPHY APRN, FNP-BC, RNFA

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	363LF0000X	Family Nurse Practitioner	316858	AZ
2	163WR0006X	Registered Nurse First Assistant	RN205967	AZ

General Provider Information

NPI Number	:	1437745106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANE TIMOTHY MCMURPHY APRN, FNP-BC, RNFA

Provider Business Mailing Address
First Line	:	601 DR MARTIN LUTHER KING JR AVE NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87102-3619
Country	:	US
Telephone Number	:	928-310-4614
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 DR MARTIN LUTHER KING JR AVE NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87102-3619
Country	:	US
Telephone Number	:	928-310-4614
Fax Number	:

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

Provider Enumeration Date	:	12/17/2020
Last Update Date	:	12/17/2025

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