Provider Demographics
NPI:1134243819
Name:PUMPHREY, SUSAN JENETTE (RN, FNP-C)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:JENETTE
Last Name:PUMPHREY
Suffix:
Gender:F
Credentials:RN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 E 50TH ST
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-4920
Mailing Address - Country:US
Mailing Address - Phone:417-556-3400
Mailing Address - Fax:
Practice Address - Street 1:202 E 50TH ST
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-4920
Practice Address - Country:US
Practice Address - Phone:417-556-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO102682363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO429150204Medicaid