Provider Demographics
NPI:1508819293
Name:PAMPATI, JAYALAKSHMI (MD)
Entity Type:Individual
Prefix:DR
First Name:JAYALAKSHMI
Middle Name:
Last Name:PAMPATI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1908 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-2503
Mailing Address - Country:US
Mailing Address - Phone:606-439-4129
Mailing Address - Fax:
Practice Address - Street 1:1908 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-2505
Practice Address - Country:US
Practice Address - Phone:606-439-4129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY27723207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64277239Medicaid
KY0501407Medicare PIN
KY0695901Medicare ID - Type Unspecified
KYE68248Medicare UPIN
00237005Medicare PIN
KY110169379Medicare PIN