MEDICARE: MICHAEL EDWARD MURPHY APN

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	363L00000X	Nurse Practitioner	A01775	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5T894	OTHER	AR	BLUE CROSS

General Provider Information

NPI Number	:	1558470815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL EDWARD MURPHY APN

Provider Business Mailing Address
First Line	:	PO BOX 879
Second Line	:
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72702-0879
Country	:	US
Telephone Number	:	479-713-7115
Fax Number	:	479-713-7186

Provider Business Practice Location Address
First Line	:	146 PASSION PLAY RD
Second Line	:
City	:	EUREKA SPRINGS
State	:	AR
Zip	:	72632-9495
Country	:	US
Telephone Number	:	479-253-9746
Fax Number	:	479-253-2464

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/08/2007

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