Provider Demographics
NPI:1538383609
Name:MURDICK, KELLY FRANCES (LMT)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:FRANCES
Last Name:MURDICK
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 10TH ST
Mailing Address - Street 2:
Mailing Address - City:HOLLY HILL
Mailing Address - State:FL
Mailing Address - Zip Code:32117-3310
Mailing Address - Country:US
Mailing Address - Phone:386-453-7434
Mailing Address - Fax:386-615-4577
Practice Address - Street 1:721 10TH ST
Practice Address - Street 2:
Practice Address - City:HOLLY HILL
Practice Address - State:FL
Practice Address - Zip Code:32117-3310
Practice Address - Country:US
Practice Address - Phone:386-453-7434
Practice Address - Fax:386-615-4577
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 30249174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist