Provider Demographics
NPI:1053873083
Name:MURRAY, MADDISON BLAIR (FNP)
Entity type:Individual
Prefix:
First Name:MADDISON
Middle Name:BLAIR
Last Name:MURRAY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 VINTAGE GREEN LN UNIT 104
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-2354
Mailing Address - Country:US
Mailing Address - Phone:615-804-2126
Mailing Address - Fax:
Practice Address - Street 1:1202 SOUTH JAMES CAMPBELL BOULEVARD
Practice Address - Street 2:SUITE 17
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-3840
Practice Address - Country:US
Practice Address - Phone:931-840-8525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-31
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-166351163W00000X
TN28445363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse