Basic Information
| Provider Information | |||||||||
| NPI: | 1780786194 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MURPHY | ||||||||
| FirstName: | PAMELA | ||||||||
| MiddleName: | SUE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 302 N HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | GIRARD | ||||||||
| State: | KS | ||||||||
| PostalCode: | 667432000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6207248291 | ||||||||
| FaxNumber: | 6207245195 | ||||||||
| Practice Location | |||||||||
| Address1: | 1011 N 69 HIGHWAY | ||||||||
| Address2: | |||||||||
| City: | FRONTENAC | ||||||||
| State: | KS | ||||||||
| PostalCode: | 66763 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6202351377 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/05/2006 | ||||||||
| LastUpdateDate: | 04/22/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 45110 | KS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 500019201 | 01 | KS | PALMETTO GBA | OTHER | 100386410B | 05 | KS | MEDICAID |