MEDICARE: YVETTE BURKHART AGPCNP-BC

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	363LG0600X	Gerontology Nurse Practitioner	AP137548	TX

General Provider Information

NPI Number	:	1922599158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YVETTE BURKHART AGPCNP-BC

Provider Business Mailing Address
First Line	:	9727 POTEET JOURDANTON FWY STE 101
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78211-4575
Country	:	US
Telephone Number	:	210-881-0643
Fax Number	:

Provider Business Practice Location Address
First Line	:	9727 POTEET JOURDANTON FWY
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78211-4574
Country	:	US
Telephone Number	:	210-881-0643
Fax Number	:

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

Provider Enumeration Date	:	05/23/2018
Last Update Date	:	02/19/2019

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