Provider Demographics
NPI:1154524536
Name:MURRELL, STACEY L (NP)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:L
Last Name:MURRELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 530
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:47362-0530
Mailing Address - Country:US
Mailing Address - Phone:765-521-1217
Mailing Address - Fax:765-521-1218
Practice Address - Street 1:5515 W 38TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-2919
Practice Address - Country:US
Practice Address - Phone:317-880-3838
Practice Address - Fax:317-880-0081
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2023-07-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN71000234A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200458570Medicaid
IN71000234AOtherSTATE LICENSE