Provider Demographics
NPI:1316077829
Name:CHILDRESS-MURPHY, NANCY ANN (DO)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:ANN
Last Name:CHILDRESS-MURPHY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:
Other - Last Name:MURPHY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:14536 E 550 RD
Mailing Address - Street 2:
Mailing Address - City:INOLA
Mailing Address - State:OK
Mailing Address - Zip Code:74036-5301
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1755 STATE HWY 66
Practice Address - Street 2:SUITE F
Practice Address - City:CATOOSA
Practice Address - State:OK
Practice Address - Zip Code:74015
Practice Address - Country:US
Practice Address - Phone:918-739-4885
Practice Address - Fax:918-739-4886
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK45422084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200196760AMedicaid