Provider Demographics
NPI:1023344074
Name:MURRAY, JEANIE KATHLEEN (RN)
Entity type:Individual
Prefix:
First Name:JEANIE
Middle Name:KATHLEEN
Last Name:MURRAY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3840 HULEN ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-7277
Mailing Address - Country:US
Mailing Address - Phone:817-253-6228
Mailing Address - Fax:817-569-5249
Practice Address - Street 1:3840 HULEN ST
Practice Address - Street 2:SUITE 400
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-7277
Practice Address - Country:US
Practice Address - Phone:817-253-6228
Practice Address - Fax:817-569-5249
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-27
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX254103163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX254103OtherRN
TX153W00000XOtherTAXONOMY