MEDICARE: DR. KRISHNA KISHORE KAMBHAMPATI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	N4506	TX

General Provider Information

NPI Number	:	1750387122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISHNA KISHORE KAMBHAMPATI M.D.

Provider Business Mailing Address
First Line	:	2423 WILLIAMS DR STE 107
Second Line	:
City	:	GEORGETOWN
State	:	TX
Zip	:	78628-3269
Country	:	US
Telephone Number	:	877-800-5722
Fax Number	:

Provider Business Practice Location Address
First Line	:	3950 N A W GRIMES BLVD # N102
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78665-3540
Country	:	US
Telephone Number	:	877-800-5722
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	07/01/2025

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