Provider Demographics
NPI:1780049684
Name:AKUMALLA, PADMA
Entity type:Individual
Prefix:
First Name:PADMA
Middle Name:
Last Name:AKUMALLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1719 FAITH CT
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-6601
Mailing Address - Country:US
Mailing Address - Phone:314-629-7552
Mailing Address - Fax:
Practice Address - Street 1:1 BARNES JEWISH HOSPITAL
Practice Address - Street 2:SOUTH KINGS HIGHWAY
Practice Address - City:STLOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110
Practice Address - Country:US
Practice Address - Phone:314-362-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-18
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003015640163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant