Provider Demographics
NPI:1487271961
Name:MURRAY, KELLEY
Entity type:Individual
Prefix:
First Name:KELLEY
Middle Name:
Last Name:MURRAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2940 OLD TROON DR APT B
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45324-7513
Mailing Address - Country:US
Mailing Address - Phone:513-939-5780
Mailing Address - Fax:
Practice Address - Street 1:2940 OLD TROON DR APT B
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45324-7513
Practice Address - Country:US
Practice Address - Phone:513-939-5780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-30
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker