Healthcare Provider Details

I. General information

NPI: 1104705748
Provider Name (Legal Business Name): POOJITHA KANUPARTHI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2025
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 LEADER AVE RM 9A
LEXINGTON KY
40508-3215
US

IV. Provider business mailing address

138 LEADER AVE RM 9A
LEXINGTON KY
40508-3215
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-1850
  • Fax: 859-257-1439
Mailing address:
  • Phone: 859-323-1850
  • Fax: 859-257-1439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberFT883
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: