Basic Information
| Provider Information | |||||||||
| NPI: | 1386843233 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURCKARDT | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | R. | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 909 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402010909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5028525841 | ||||||||
| FaxNumber: | 5028521359 | ||||||||
| Practice Location | |||||||||
| Address1: | 401 E CHESTNUT ST UNIT 690 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402025706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5028525841 | ||||||||
| FaxNumber: | 5028521359 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2007 | ||||||||
| LastUpdateDate: | 06/21/2019 | ||||||||
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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 | 363LA2100X | 3005218 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | 363L00000X | 3005216 | KY | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 000000626497 | 01 | KY | ANTHEM | OTHER | 7100013980 | 05 | KY | MEDICAID | 50025465 | 01 | KY | PASSPORT | OTHER | P00824827 | 01 | KY | RAILROAD MEDICARE KY | OTHER | 50048427 | 01 | KY | PASSPORT - CTS | OTHER | 000000642019 | 01 | KY | ANTHEM - NNIKY | OTHER | 000028412N | 01 | KY | HUMANA - NNIKY | OTHER | 106198 | 01 | KY | SIHO | OTHER |