Provider Demographics
NPI:1386778363
Name:MURPHY, KATHLEEN (PA-C)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:
Last Name:MURPHY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 DERBY NOTCH SW
Mailing Address - Street 2:
Mailing Address - City:OCEAN ISLE BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28469-1337
Mailing Address - Country:US
Mailing Address - Phone:302-379-9827
Mailing Address - Fax:
Practice Address - Street 1:712 VILLAGE RD SW STE 104
Practice Address - Street 2:
Practice Address - City:SHALLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28470
Practice Address - Country:US
Practice Address - Phone:910-754-7607
Practice Address - Fax:910-754-7608
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC5-0000553363AS0400X
NC0010-06831363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical