MEDICARE: TERESA DIANN MURPHY RD, 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	2542	KY

General Provider Information

NPI Number	:	1609243203
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA DIANN MURPHY RD, LD

Provider Business Mailing Address
First Line	:	181 LEES VALLEY RD
Second Line	:
City	:	SHEPHERDSVILLE
State	:	KY
Zip	:	40165-6143
Country	:	US
Telephone Number	:	502-955-7837
Fax Number	:	502-543-2998

Provider Business Practice Location Address
First Line	:	181 LEES VALLEY RD
Second Line	:
City	:	SHEPHERDSVILLE
State	:	KY
Zip	:	40165-6143
Country	:	US
Telephone Number	:	502-955-7837
Fax Number	:	502-543-2998

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

Provider Enumeration Date	:	08/31/2015
Last Update Date	:	08/31/2015

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