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NPI Code Detail

MEDICARE: TYISAIA MURRAY PMHNP

MEDICARE: TYISAIA MURRAY PMHNP
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner1117629TX

General Provider Information

NPI Number : 1831978857
Entity Type Code : Individual
Provider Name (Legal Business Name) : TYISAIA MURRAY PMHNP
Provider Business Mailing Address
First Line : PO BOX 11167
Second Line :
City : FORT WAYNE
State : IN
Zip : 46856-1167
Country : US
Telephone Number : 574-546-1900
Fax Number : 574-546-1999
Provider Business Practice Location Address
First Line : 1999 BRYAN ST STE 900
Second Line :
City : DALLAS
State : TX
Zip : 75201-3140
Country : US
Telephone Number : 574-546-1900
Fax Number : 574-546-1999
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/28/2023
Last Update Date : 05/28/2026

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