Healthcare Provider Details

I. General information

NPI: 1124910708
Provider Name (Legal Business Name): JAN MURPHY MSN, RN, NPD-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2025
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS PL
SAINT LOUIS MO
63110-1081
US

IV. Provider business mailing address

6100 BROOKPARC DR
IMPERIAL MO
63052-2888
US

V. Phone/Fax

Practice location:
  • Phone: 918-810-8301
  • Fax:
Mailing address:
  • Phone: 314-285-9108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License Number140279
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: