Provider Demographics
NPI:1992299705
Name:MURPHY, KENDALL DAVID
Entity type:Individual
Prefix:
First Name:KENDALL
Middle Name:DAVID
Last Name:MURPHY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2282 JOHNSTON AVE
Mailing Address - Street 2:
Mailing Address - City:TWIN LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49457-9328
Mailing Address - Country:US
Mailing Address - Phone:231-855-3552
Mailing Address - Fax:
Practice Address - Street 1:1000 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:FORT MORGAN
Practice Address - State:CO
Practice Address - Zip Code:80701-3290
Practice Address - Country:US
Practice Address - Phone:970-867-3391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-15
Last Update Date:2024-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704313412367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered