Healthcare Provider Details

I. General information

NPI: 1629070503
Provider Name (Legal Business Name): AMY LEE BURKHARDT CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 MONTLIMAR DR STE 500
MOBILE AL
36609-1794
US

IV. Provider business mailing address

1110 MONTLIMAR DR STE 500
MOBILE AL
36609-1794
US

V. Phone/Fax

Practice location:
  • Phone: 251-490-1864
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1853
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1-084741
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: