Provider Demographics
NPI:1013055359
Name:KUMAR, PURNIMA (PHD)
Entity type:Individual
Prefix:DR
First Name:PURNIMA
Middle Name:
Last Name:KUMAR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4615 REED BARK LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-1876
Mailing Address - Country:US
Mailing Address - Phone:904-399-0324
Mailing Address - Fax:904-399-0420
Practice Address - Street 1:5251 EMERSON ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-4932
Practice Address - Country:US
Practice Address - Phone:904-399-0324
Practice Address - Fax:904-399-0420
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5808103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001905500Medicaid
GA779231363AMedicaid
GA779231363AMedicaid
FL54649YMedicare PIN
FL001905500Medicaid