Individual
SOUMYASRI KAMBHATLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
300 CARSON ST, JONESBORO, AR 72401-3104
(870) 932-1198
Mailing address
300 CARSON ST, JONESBORO, AR 72401-3104
(870) 932-1198
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
01095080A
IN
207R00000X
Internal Medicine Physician
125069809
IL
207RR0500X
Rheumatology Physician
01095080A
IN
207RR0500X
Rheumatology Physician
Primary
036152890
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1103780407
ANTHEM PTAN
IN
05
—
300100767
—
IN
Enumeration date
06/09/2017
Last updated
02/17/2025
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