MEDICARE: MRS. KATHLEEN ELIZABETH BURNETT PA-C

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	363A00000X	Physician Assistant	PA09444	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528467875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHLEEN ELIZABETH BURNETT PA-C

Provider Business Mailing Address
First Line	:	P.O. BOX 961205
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76161-1205
Country	:	US
Telephone Number	:	817-740-8400
Fax Number	:	817-378-3699

Provider Business Practice Location Address
First Line	:	5801 OAKBEND TRAIL, SUITE 180
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-3915
Country	:	US
Telephone Number	:	817-423-2002
Fax Number	:	817-423-2004

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

Provider Enumeration Date	:	08/21/2014
Last Update Date	:	12/16/2016

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