Healthcare Provider Details

I. General information

NPI: 1528178860
Provider Name (Legal Business Name): KATHRYN MARIE MCMURPHY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 12/11/2020
Certification Date: 12/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1506 SIOUX DR
MARION IL
62959-5209
US

IV. Provider business mailing address

109 CALIFORNIA ST PO BOX 577
CARTERVILLE IL
62918-1923
US

V. Phone/Fax

Practice location:
  • Phone: 618-997-5270
  • Fax: 618-997-5029
Mailing address:
  • Phone: 618-985-8221
  • Fax: 618-985-6860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number085-000594
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: