Healthcare Provider Details

I. General information

NPI: 1528985637
Provider Name (Legal Business Name): DR. PAVANI BATTULA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 MADISON ST
JEFFERSON CITY MO
65101
US

IV. Provider business mailing address

4101 LEDGER DR APT 301
COLUMBIA MO
65201
US

V. Phone/Fax

Practice location:
  • Phone: 573-632-5301
  • Fax:
Mailing address:
  • Phone: 402-885-4990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2026023681
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: