Provider Demographics
NPI:1962914804
Name:MURPHY, TERI K (CNP)
Entity type:Individual
Prefix:
First Name:TERI
Middle Name:K
Last Name:MURPHY
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1134 N MAIN ST STE 1100
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311-2379
Mailing Address - Country:US
Mailing Address - Phone:937-651-6820
Mailing Address - Fax:937-651-6822
Practice Address - Street 1:8200 STATE ROUTE 366 STE 8
Practice Address - Street 2:
Practice Address - City:RUSSELLS POINT
Practice Address - State:OH
Practice Address - Zip Code:43348-9670
Practice Address - Country:US
Practice Address - Phone:937-292-5063
Practice Address - Fax:937-292-5073
Is Sole Proprietor?:No
Enumeration Date:2017-11-01
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.021970363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0255181Medicaid