Healthcare Provider Details

I. General information

NPI: 1689844243
Provider Name (Legal Business Name): KUMARI K. WEERATUNGE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2008
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 ANDOVER LN
LIVINGSTON TX
77351-2685
US

IV. Provider business mailing address

204 W PARK
LIVINGSTON TX
77351-9336
US

V. Phone/Fax

Practice location:
  • Phone: 936-327-8661
  • Fax: 936-327-3131
Mailing address:
  • Phone: 936-327-8661
  • Fax: 936-327-3131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberM9087
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberM9087
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: