Healthcare Provider Details

I. General information

NPI: 1952973349
Provider Name (Legal Business Name): KANJANAMALA AGORAMURTHI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2021
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS WAY # 512-19B
LITTLE ROCK AR
72202-3500
US

IV. Provider business mailing address

16000 RUSHMORE AVE APT 5203
LITTLE ROCK AR
72223-7018
US

V. Phone/Fax

Practice location:
  • Phone: 501-364-3976
  • Fax:
Mailing address:
  • Phone: 818-319-7853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberE-20047
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: