Basic Information
Provider Information | |||||||||
NPI: | 1588124218 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MURPHY | ||||||||
FirstName: | JENNIFER | ||||||||
MiddleName: | BANNISTER | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | DO | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | BANNISTER | ||||||||
OtherFirstName: | JENNIFER | ||||||||
OtherMiddleName: | RENA | ||||||||
OtherNamePrefix: | MS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | DO | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 332 PRINCESS ARCH LANE | ||||||||
Address2: |   | ||||||||
City: | LEXINGTON | ||||||||
State: | KY | ||||||||
PostalCode: | 40511 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4237949430 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | UNIVERSITY OF KENTUCKY HEALTH CARE | ||||||||
Address2: | 115 SCOVELL HALL | ||||||||
City: | LEXINGTON | ||||||||
State: | KY | ||||||||
PostalCode: | 40506 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8592575272 | ||||||||
FaxNumber: | 8593231123 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/20/2019 | ||||||||
LastUpdateDate: | 01/13/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 01/13/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X |   |   | Y |   | Student, Health Care | Student in an Organized Health Care Education/Training Program |   |
No ID Information.