Individual
MRS. KAVITA PENDURTHI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
600 E 5TH ST, FULTON STATE HOSPITAL, FULTON, MO 65251-1753
(573) 592-4100
(573) 592-3023
Mailing address
600 E 5TH ST, FULTON STATE HOSPITAL, FULTON, MO 65251-1753
(573) 592-4100
(573) 592-3023
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
MO100691
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
208219501
—
MO
Enumeration date
08/11/2006
Last updated
06/23/2008
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