Provider Demographics
NPI:1285770040
Name:CUNNINGHAM, KARRIE A (MD)
Entity type:Individual
Prefix:DR
First Name:KARRIE
Middle Name:A
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2580
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65801-2580
Mailing Address - Country:US
Mailing Address - Phone:417-829-4620
Mailing Address - Fax:417-829-4316
Practice Address - Street 1:1605 MARTIN SPRINGS DR
Practice Address - Street 2:SUITE 320
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-2931
Practice Address - Country:US
Practice Address - Phone:573-458-6359
Practice Address - Fax:573-458-6826
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2009-09-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2001002803207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205686405Medicaid
MO205686405Medicaid
MO918253230Medicare PIN