Provider Demographics
NPI:1588124218
Name:MURPHY, JENNIFER BANNISTER (DO)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:BANNISTER
Last Name:MURPHY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:RENA
Other - Last Name:BANNISTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 2379
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-2379
Mailing Address - Country:US
Mailing Address - Phone:606-408-9571
Mailing Address - Fax:
Practice Address - Street 1:617 23RD ST STE 8B
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-2845
Practice Address - Country:US
Practice Address - Phone:606-408-1290
Practice Address - Fax:606-408-6640
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR5155208100000X
390200000X
KY05533208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program