Provider Demographics
NPI:1396120432
Name:MURPHY, VANESSA G (NP)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:G
Last Name:MURPHY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:601 E SOUTHLAKE BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6251
Mailing Address - Country:US
Mailing Address - Phone:817-488-1956
Mailing Address - Fax:817-488-8675
Practice Address - Street 1:601 E SOUTHLAKE BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6251
Practice Address - Country:US
Practice Address - Phone:817-488-1956
Practice Address - Fax:817-488-8675
Is Sole Proprietor?:No
Enumeration Date:2015-07-29
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP128430363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX431947YKPWMedicare PIN
TX431947YKQLMedicare PIN