MEDICARE: KAITLYNN BURKETT BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-26-88241	TN

General Provider Information

NPI Number	:	1144099243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLYNN BURKETT BCBA

Provider Business Mailing Address
First Line	:	79 SAND PEBBLE DR STE A&B
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38305-7591
Country	:	US
Telephone Number	:	901-443-9146
Fax Number	:

Provider Business Practice Location Address
First Line	:	79 SAND PEBBLE DR STE A&B
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38305-7591
Country	:	US
Telephone Number	:	901-443-9146
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2023
Last Update Date	:	03/24/2026

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