Healthcare Provider Details

I. General information

NPI: 1821550369
Provider Name (Legal Business Name): ASHNA PUDUPAKKAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2019
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 SOUTH 31ST STREET MS-CK-300
TEMPLE TX
76508
US

IV. Provider business mailing address

2401 SOUTH 31ST STREET MS-CK-300
TEMPLE TX
76508
US

V. Phone/Fax

Practice location:
  • Phone: 254-935-5063
  • Fax:
Mailing address:
  • Phone: 254-935-5063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License NumberT6017
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: