Healthcare Provider Details

I. General information

NPI: 1396001103
Provider Name (Legal Business Name): PEARL QUARTEY-KUMAPLEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2012
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 SE 4TH ST
EVANSVILLE IN
47708-1607
US

IV. Provider business mailing address

120 SE 4TH ST
EVANSVILLE IN
47708-1607
US

V. Phone/Fax

Practice location:
  • Phone: 812-426-9372
  • Fax: 812-450-0077
Mailing address:
  • Phone: 812-450-6815
  • Fax: 812-450-6822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number036.143097
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01084587A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: