Basic Information
| Provider Information | |||||||||
| NPI: | 1164504429 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURNS | ||||||||
| FirstName: | KRISTEN | ||||||||
| MiddleName: | JEAN | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 VILLAGE HARBOR DR | ||||||||
| Address2: | |||||||||
| City: | LAKE WYLIE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 297109092 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8036312858 | ||||||||
| FaxNumber: | 8036312862 | ||||||||
| Practice Location | |||||||||
| Address1: | 1200 VILLAGE HARBOR DR | ||||||||
| Address2: | |||||||||
| City: | LAKE WYLIE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 297109092 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8036312858 | ||||||||
| FaxNumber: | 8036312862 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2006 | ||||||||
| LastUpdateDate: | 06/11/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 0050-02299 | NC | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363L00000X | 109057 | SC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.