Doctor Name: | KELLY MURRAY |
NPI Number: | 1043247695 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CNM |
License Number: | 209003242 |
Business Practice Address: | 2246 Illinois State Route 157 Suite 100 Glen Carbon, IL - 62034 |
Business Phone Number: | 6182889251 |
Business Fax Number: | 6182886900 |
Mailing Address: | 2246 Illinois State Route 157, Suite 100 GLEN CARBON |
State: | IL |
Postal Code: | 62034 |
Phone Number: | 6182889251 |
Fax Number: | 6182886900 |
NPI Enumeration Date: | 06/27/2006 |
NPI Last Update Date: | 12/16/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LX0001X |
License Number: | 209003242 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | IL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Obstetrics & Gynecology |
Taxonomy Definition: |