Basic Information
| Provider Information | |||||||||
| NPI: | 1003184433 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BURKHARDT | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | P | ||||||||
| NamePrefix: | DR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 149 PLANTATION RIDGE DR | ||||||||
| Address2: | SUITE 190 | ||||||||
| City: | MOORESVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281179174 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7046580595 | ||||||||
| FaxNumber: | 7046580916 | ||||||||
| Practice Location | |||||||||
| Address1: | 149 PLANTATION RIDGE DR | ||||||||
| Address2: | SUITE 190 | ||||||||
| City: | MOORESVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281179174 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7046580595 | ||||||||
| FaxNumber: | 7046580916 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2011 | ||||||||
| LastUpdateDate: | 09/05/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | AT006132 | PA | N | Speech, Language and Hearing Service Providers | Audiologist | 231H00000X | 10128 | NC | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.