JERIL ANTHONY KANNAMPUZHA (NPI# 1487072906) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1487072906 |
| Entity Type | Individual |
| Full Name | JERIL ANTHONY KANNAMPUZHA |
| Credential | M.D. |
| Practice Address |
1400 College Dr Ste 204 Texarkana TX 75503 |
| Mailing Address |
Po Box 1326 Marshall TX 75671-1326 |
| Practice Telephone | 9037929327 |
| Practice Fax Number | 9037919353 |
| Mailing Telephone | 9039273782 |
| Mailing Fax Number | 9039271764 |
| Enumeration Date | 2014-04-01 |
| Last Update Date | 2020-05-12 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | Q9840 | TX | Allopathic & Osteopathic Physicians |
| N | 208000000X | Pediatrics | 955120 | NY | Allopathic & Osteopathic Physicians |
| Street Address |
1400 COLLEGE DR STE 204 |
| City | TEXARKANA |
| State | TX |
| Zip Code | 75503 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134313802 | Valerie Ann Smith | General Practice | 1400 College Dr Ste 204, Texarkana, TX 75503-3575 | 2007-09-05 |
| 1821554296 | Tirsa Elaine Miller | Nurse Practitioner | 1400 College Dr Ste 204, Texarkana, TX 75503-3575 | 2019-02-11 |
| 1316412844 | Stephanie Ann Stewart | Nurse Practitioner | 1400 College Dr Ste 204, Texarkana, TX 75503-3575 | 2018-10-11 |
| 1568956456 | Andrew Lourens | Family Medicine | 1400 College Dr Ste 204, Texarkana, TX 75503-3575 | 2018-06-14 |
| 1538673140 | Kristine Johansson Yells | Social Worker | 1400 College Dr Ste 204, Texarkana, TX 75503-3575 | 2017-11-20 |
| 1598286734 | Stephanie Ford | Nurse Practitioner | 1400 College Dr Ste 204, Texarkana, TX 75503-3575 | 2017-06-28 |
| 1841729480 | Mikala Brooke Anderson | Pediatrics | 1400 College Dr Ste 204, Texarkana, TX 75503-3575 | 2017-06-07 |
| 1285060012 | Danette Allen | Social Worker | 1400 College Dr Ste 204, Texarkana, TX 75503-3575 | 2013-09-25 |
| 1124396833 | Krista Rae Niemeyer | Nurse Practitioner | 1400 College Dr Ste 204, Texarkana, TX 75503-3575 | 2011-12-08 |
| 1417243700 | Kristen Lynn Coats | Registered Nurse | 1400 College Dr Ste 204, Texarkana, TX 75503 | 2011-06-24 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770049397 | Jeffery Nash | Nurse Practitioner | #4 Valley View Circle, Texarkana, TX 75503 | 2019-02-19 |
| 1821583501 | Brandy D Acker | Psychologist | 3615 Richmond Rd, Texarkana, TX 75503 | 2018-06-26 |
| 1366935066 | Samantha Lee Harris | Nurse Practitioner | 4116 Mcknight Rd, Texarkana, TX 75503 | 2018-06-07 |
| 1811416910 | Heather Alison Gerber | Nurse Practitioner | 5903 Brenda Street, Texarkana, TX 75503 | 2017-09-11 |
| 1952838682 | John Kyle Abney | Counselor | 4134 Mcknight Rd, Texarkana, TX 75503 | 2017-05-12 |
| 1699151514 | Piney Woods Er IIi LLC | Clinic/Center | 4102 Gibson Lane, Texarkana, TX 75503 | 2015-08-03 |
| 1609282433 | Colby Rebecca Pair | Physician Assistant | 2604 St. Michael Dr., Suite 310, Texarkana, TX 75503 | 2014-07-01 |
| 1265842496 | Healthcare Express, LLP | Clinic/Center | 3513 Richmond Rd, Texarkana, TX 75503 | 2014-04-28 |
| 1134540628 | Eagle Dental Center of Texarkana Pllc | Dentist | 4009 Moores Ln, Texarkana, TX 75503 | 2013-12-30 |
| 1326481664 | Juancarlo S. Pascual | Family Medicine | 604 St. Michael Dr, Suite 340, Texarkana, TX 75503 | 2013-04-16 |
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| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629395520 | Tracie Shenelle Calloway-lawson | Pediatrics | 4503 Texas Blvd, Texarkana, TX 75503-3026 | 2010-05-01 |
| 1487617031 | Kevin Earl Kramer | Pediatrics | 4077 Jefferson Ave, Texarkana, AR 71854-1509 | 2006-04-06 |
| 1841729480 | Mikala Brooke Anderson | Pediatrics | 1400 College Dr Ste 204, Texarkana, TX 75503-3575 | 2017-06-07 |
| 1285908335 | B Pediatrics Pllc | Pediatrics | 4503 Texas Blvd, Texarkana, TX 75503-3026 | 2012-03-06 |
| 1578866547 | Burns Professional Office | Pediatrics | 4503 Texas Blvd, Texarkana, TX 75503-3026 | 2010-12-14 |
| 1407163066 | Nam Thai Nguyen | Pediatrics | 1400 College Dr Ste 204, Texarkana, TX 75503-3575 | 2010-09-02 |
| 1144459231 | Debra Shanelle Wright-bowers | Pediatrics | 5002 Cowhorn Creek Rd, Texarkana, TX 75503 | 2009-07-09 |
| 1285853515 | Zachariah W. King | Pediatrics | 5002 Cowhorn Creek Rd, Texarkana, TX 75503-9766 | 2007-04-25 |
| 1598743247 | Cheryl L Saul-sehy | Pediatrics | 5002 Cowhorn Creek Rd, Texarkana, TX 75503-9766 | 2006-01-04 |
| 1588646301 | Collom and Carney Clinic Association | Pediatrics | 5002 Cowhorn Creek Rd, Texarkana, TX 75503-9766 | 2005-11-17 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.