Healthcare Provider Details

I. General information

NPI: 1902287436
Provider Name (Legal Business Name): FARAH KUDRATH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2015
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N TEXAS AVE STE A
WEBSTER TX
77598-4961
US

IV. Provider business mailing address

400 N TEXAS AVE STE A
WEBSTER TX
77598-4961
US

V. Phone/Fax

Practice location:
  • Phone: 281-338-2798
  • Fax: 281-557-2097
Mailing address:
  • Phone: 813-382-7982
  • Fax: 281-557-2097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberT7625
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: