Basic Information
| Provider Information | |||||||||
| NPI: | 1194067546 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURKHART | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | GANN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | AGPCNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 281 | ||||||||
| Address2: | |||||||||
| City: | WENTWORTH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 273750281 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3364279022 | ||||||||
| FaxNumber: | 3364279030 | ||||||||
| Practice Location | |||||||||
| Address1: | 2150 NC HIGHWAY 65 | ||||||||
| Address2: | |||||||||
| City: | REIDSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 273209609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3364279022 | ||||||||
| FaxNumber: | 3364279030 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2013 | ||||||||
| LastUpdateDate: | 03/09/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 5006120 | NC | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LG0600X | 5006120 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology |
No ID Information.