Provider Demographics
NPI:1760853436
Name:MURPHY, GRACE ELLEN (CFNP)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:ELLEN
Last Name:MURPHY
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:591 KINGTOWN RD
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:TN
Mailing Address - Zip Code:37892-2228
Mailing Address - Country:US
Mailing Address - Phone:423-539-7864
Mailing Address - Fax:
Practice Address - Street 1:460 INDUSTRIAL LN
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:TN
Practice Address - Zip Code:37841
Practice Address - Country:US
Practice Address - Phone:423-286-4141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-07
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20552363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6087351OtherBCBS TN
TN1035I03874OtherTN MEDICARE